Background: Lectures are the most common education form at medical conferences. For simplicity sake, generally, the lecturer stands in front of a group of learners and disseminates information via the use of slides. Learning theories, such as Mayer’s cognitive theory of multimedia learning, have shown that learners can either process visual or auditory information but not both simultaneously. Additionally, this processing is finite. One of the key lessons in presentation design, from psychological theories of learning, is to replace text with visual representations while the presenter tells a story. This has also been shown to help improve retention of knowledge [2,3]. Most of the studies that show this are supported by medical student classroom learning environments. Little research has been performed in adult learning environments. Read more →
Background: Skin and soft tissue abscesses are a common emergency department (ED) presentation. The approach to management has changed little in recent decades: incision and drainage (I+D) and then discharge home with follow up. However, increasing rates of methicillin-resistant staph aureus (MRSA) over the last decade have led to further consideration of adjunct therapy with oral antibiotics to improve cure rates. Two recent studies (Talan 2016, Daum 2017) have shown a modest but consistent benefit to oral antibiotics. Read more →
Background: There have now been several trials published on the use of steroids in sepsis. In 2002, we had the Annane Trial, with 299 patients showing mortality and shock reversal benefit in sepsis with hydrocortisone. Then in 2008 we had the CORTICUS trial, with 499 patients, which found a faster reversal of shock, but no benefit in mortality. Next the HYPRESS trial published in 2016 with 380 patients, with severe sepsis, not septic shock, showed no difference in mortality or time to reversal of shock. And finally the ADRENAL Trial published this year with 3800 patients show no difference in mortality, but a small benefit in reversal of shock. Due to these mixed results, many physicians have variable practice patterns with the use of steroids in sepsis/septic shock. Now, we have the APROCCHSS trial looking at hydrocortisone plus fludrocortisone for adults with septic shock (By the way the lead author is the same author that published the 2002 steroids in sepsis trial…Annane). Read more →
Background: Over the last three years, we have seen the rise of neurointerventional therapies for patients with ischemic strokes due to large vessel occlusions (LVOs). This group of strokes typically includes patients with occlusion of the distal intracranial carotid artery, middle cerebral artery or anterior cerebral artery. Rapid identification of these patients both in the prehospital setting as well as in the emergency department (ED) may be beneficial as it can lead to mobilization of necessary resources and ordering of proper investigations (CT perfusion, MRI/MRA). While there are a number of clinical scoring systems in place to identify patients with LVO, none are ideal. The authors investigate the utility of the vision, aphasia, neglect (VAN) assessment for this purpose. Read more →
Background: Welcome back to REBEL Cast episode 47. In this issue we are going to talk about some recent trials published in the past year that have gotten some love in the FOAMed world. We have been meaning to discuss these trials, but just simply didn’t have the time until now. What trials are we reviewing?
- The age of PRBCs in transfusion
- The usefulness of lidocaine in renal colic
- The utility of oxygen therapy in Stroke