Journal Club Articles

Risk of Intravenous Contrast Material–mediated Acute Kidney Injury: A Propensity Score–matched Study Stratified by Baseline-estimated Glomerular Filtration Rate
Jennifer S. McDonald, Robert J. McDonald, Rickey E. Carter, Richard W. Katzberg, David F. Kallmes, and Eric E. Williamson
Radiology 2014 271:1 , 65-73
DOI: http://dx.doi.org/10.1148/radiol.13130775

 
Intravenous Contrast Material Exposure Is Not an Independent Risk Factor for Dialysis or Mortality
Robert J. McDonald, Jennifer S. McDonald, Rickey E. Carter, Robert P. Hartman, Richard W. Katzberg, David F. Kallmes, and Eric E. Williamson
Radiology 2014 273:3 , 714-725
DOI: http://dx.doi.org/10.1148/radiol.14132418

NEJM Article (Via Dr. Johnson)

http://www.nejm.org/doi/full/10.1056/NEJMsa1406143

Trends in Opioid Analgesic Abuse and Mortality in the United States
Richard C. Dart, M.D., Ph.D., Hilary L. Surratt, Ph.D., Theodore J. Cicero, Ph.D., Mark W. Parrino, M.P.A., S. Geoff Severtson, Ph.D., Becki Bucher-Bartelson, Ph.D., and Jody L. Green, Ph.D.
N Engl J Med 2015; 372:241-248 January 15, 2015 DOI: 10.1056/NEJMsa1406143

Recommended Reading from Gary Johnson

Dr. Johnson writes:

“Lack of efficacy of als care makes the nyt …..

When options are available, it’s tempting to go for the maximum treatment. But that doesn’t necessarily lead to better outcomes.”

Doing More for Patients Often Does No Good
Aaron E. Carroll
New York Times, 1/13/2015

David Rothman adds:
See also: Carroll’s blog and the GREAT patient education videos you can see at the Healthcare Triage YouTube Channel. I am especially fond of his video on vaccines and ASDs.

From Dr. Johnson: “Skip Your Annual Physical”

“Always question what you have been taught……
They cost the country billions, but they don’t save lives.”

http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html

The New York Times
Jan. 8, 2015
Ezekial J. Emanuel, oncologist and a vice provost at the University of Pennsylvania

A version of this op-ed appears in print on January 9, 2015, on page A23 of the New York edition with the headline: Skip Your Annual Physical.

Wednesday Lectures, 1/7/2015

10a Wilderness Cool Cases (Sue Biondich, new Wilderness Fellow)
Spina Bifida & Bony Abnormalities dt casting & bony density changes
…for some reason, >75% develop Latex allergy?!
Malignant Melanoma with Sz?!
Chronic subdural hematoma…
Sp MVC, paralysis & severe injuries…atlantooccipital dissociation (“internal decapitation”) almost universally fatal!
Pulmonary Artery Aneurysm incredibly rare!
Central Cord Syndrome ~ upper extremity paresthesia & most common partial spinal syndrome…
Cavitary TB hemoptysis…PTX association & PTX as pressure treatment!?
Hot Tub Guillan Barre?! Post viral diarrhea? Flu shot?

11a PSQ (Shaw)
HoTN in Trauma increases M&M!
You don’t always follow or agree with consultant’s recs…

12pm Clinical Controversy: CT/LP v CT/CTA in Dx of SAH? (Calleo)
CTA very sensitive for aneurysms…
LP has risks, worth it?
Still slightly better CT/LP vs CT/CTA?
…but CTA tech improving…

1230 TLLT Topic: Single Pill Ingestion, Tox in Peds (Calleo)
ABCDE… Symptomatic mgmt & consider decontamination… Contact PCC!
TCAs, MAOIs, Sulfonylureas, BetaBlk(hypoglycemia, glucagon, hdnarcan?), CCB(hyperglycemia, insulin, hdnarcan?), Opioids, Benzos, Barbs, Antimalarials, Antidysrhythmics, Camphor…
Know ER & XD meds for observation calculations…
Specify exact amount taken & time of onset as well as possible!
contact PCC!

1pm PD Rounds… (Paolo & Hojnowski)
UEM Website!!! <https://uemcurrentawareness.wordpress.com&gt;
SAVE & CHECK Website for PDR Days!!!
*Wound Repair Cutoffs & Management (Hojnowski)
All infections have 2 to 5% infection rate (excluding human & animal bites)
Subjective cosmesis scale not ideal…difficult to take away a hard & fast rule for timing & wound type… Benefit of Abx pox not firmly established even in high risk wounds…
<http://emj.bmj.com/content/31/2/96.full.pdf+html&gt;
*Outpatient/Prehospital NIPPV
Risk reduction for both Mortality outcomes & decreasing need for intubation in multiple pulmonary diseases (mostly CHF & COPD, although asthma & PNA also lumped in)…
EMS should use more CPAP/BiPAP for certain suspected conditions?
Heterogeneity of study outcomes within systematic review may be biased by confounders of differing dyspneic diagnoses & differing standards of baseline care.
“Start with Scopus or google scholar for systematic review” ~Dr. Grant
<http://www.annemergmed.com/article/S0196-0644(13)01587-4/pdf&gt;

Journal Club Articles (1/5/2015)

• Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared?
  James V Quinn, Steven K Polevoi, Michael A Kohn
  Emerg Med J 2014;31:2 96-100
  doi:10.1136/emermed-2012-202143
  http://emj.bmj.com/content/31/2/96
  Full text PDF: http://emj.bmj.com/content/31/2/96.full.pdf+html
• Effect of Out-of-Hospital Noninvasive Positive-Pressure Support Ventilation in Adult Patients With Severe Respiratory Distress: A Systematic Review and Meta-analysis
  Mal, Sameer et al.
  Annals of Emergency Medicine , Volume 63 , Issue 5 , 600 – 607.e1
  DOI: http://dx.doi.org/10.1016/j.annemergmed.2013.11.013
  http://www.annemergmed.com/article/S0196-0644%2813%2901587-4/abstract
  Full Text PDF: http://www.annemergmed.com/article/S0196-0644(13)01587-4/pdf