Taking a Bite from the Big Apple

Just got back from a few days in New York city where I attended McMaster's Best Evidence in Emergency Medicine course. If ever there was a place to live up to Joyce's term "blooming buzzing confusion" this was it! What a trip. Just thinking back to being at the top of the Empire State Building is enough to get that vertiginous feeling back in the pit of my stomach.

We reviewed evidence in the EM literature from the past year. Here are a few highlights:

1) "Hot Potato" - Throat swabs should not be routinely done in a primary care setting for management of sore throats. Treat with ibuprofen and leave the antibiotics out of it mostly. see http://www.sign.ac.uk/guidelines/fulltext/117/index.html"SIGN

2) "Bell Ringer" - Kupperman's new CT head rule for kids is promising as is the CATCH trial from Canada. Note: Every 1500 CT scans on children leads to one mortality from radiation!

3) "Cooler heads prevail" - Arrich's review of cooling cardiac arrest survivors demonstates a clear benefit from cooling the patients to less than 35 degrees within 6 hours of the arrest.

4) "Don't Stop for Breathing" - In this big RCCT of chest compressions only vs conventional CPR, these authors showed that in out of hospital cardiac arrest, it looks like chest compressions are the only effective form of CPR.

5) "To bleed or not to bleed" - A simple and cheap drug for a big problem. The use of transexamic acid ( 1g IV over 10 minutes then 1 g over 8 hours) in the trauma patient with significant bleeding reduced mortlity by 1.5%.

6) "A Whole Lotta Shakin Going on" - 0.5 mg Intranasal or buccal Midazolam or (0.1 mg IV) is enough to stop most pediatric seizures.

7) "Rub it to make it better" - Topical NSAIDs have a significant effect on treating acute pain without the GI side effects.

8) "Ain't no bugs in here" - acylclovir is useless in Bell's palsy. Just use steroids (prednisone is good).

9) "If Dad can do it so can I!" - Ottawa Ankle Rules validated in kids greater than 5.

10) "Was blind but now I see..." - Triage who needs a stroke work-up in TIA patients is a lot easier with the ABCD2 rule. (For patients with a low score the two-day stroke risk was 1%. )

There were lots of other goodies in this course including new guidelines for antibiotics usage in surgical infections, procedural sedation facts, migraines...

It ended with a good game of Jeopardy too. I'll have to go again I think.

Oh and by the way, if you're going to New York check out Ludlow guitars in the East Village!