June 24, 2020

Take Home Points
  • Heat stroke is a life-threatening disorder characterized by elevated core temperature, compromise to neurologic function and multi-system organ dysfunction
  • The keystone of treatment is rapid cooling within 30 minutes of presentation preferably with ice water immersion
  • Patients with heat stroke should be investigated for rhabdomyolysis, AKI, liver failure and concomitant infection

June 8, 2020

Background: Despite the initial excitement around the use of chloroquine (CQ) and hydroxychloroquine (HCQ), there is mounting evidence that neither drug is effective in COVID-19 treatment. Laboratory studies have shown antiviral and immunomodulatory properties in vitro but these have not held up in clinical application. However, one potential area of use that needs more investigation is the use of HCQ for post-exposure prophylaxis (PEP). As the pandemic continues, PEP becomes an increasingly important topic in stopping repeat surges of the disease. To date, there is no high-quality evidence on prophylactic HCQ after exposure.

June 1, 2020

Background: Humeral shaft fractures are commonly seen in the Emergency Department and emergency management is relatively straightforward: assess for other trauma, assess for radial nerve injury, analgesia, sling or functional bracing and follow up with orthopedics. However, there are debates in management specifically around operative vs non-operative management. The non-operative approach has been the standard but, the rate of surgery has markedly risen in the last decade (Schoch 2017). Operative management appears to reduce the risk of nonunion significantly but, comes with other risks including infections and iatrogenic radial nerve injuries. In the absence of high-quality evidence, marked practice variation persists.

May 27, 2020

Take Home Points
  • Small to Moderate Size Pneumothorax - consider managing conservatively with observation (need to make sure consulting services on same page)
  • Needle aspiration for spontaneous pneumothorax recommend by British Thoracic and European Respiratory Societies
  • 1 in 5 patients requiring a chest tube will suffer complications - many are iatrogenic in nature. Practice procedure via simulation 
  • Chest tubes placed for traumatic pneumothoraces should get prophylactic antibiotics
  • When deciding on treatment strategy, discuss with your consultants and make sure you have institutional buy-in.

May 14, 2020

Background: The publication of the MR CLEAN trial in January 2015 changed the face of ischemic stroke care. This was the first study demonstrating a benefit to endovascular treatment of a specific subset of ischemic stroke patients: those with a large vessel occlusion (LVO) presenting within 6 hours of symptom onset. MR CLEAN was followed by a flurry of publications seeking to replicate and refine treatment as well as expand the window for treatment. The REBEL EM team reviewed this literature back in 2018 and, with the help of Dr. Evie Marcolini, created a workflow (shown below).

One major component of LVO management is the use of systemic thrombolytics in patients presenting within the current thrombolytic treatment window prior to endovascular intervention. However, it’s unclear if systemic thrombolytic administration results in better outcomes or if it simply exposes the patient to increased risks at a higher cost. Limited evidence questions the utility of the current approach with lytics + endovascular therapy (Phan 2017, Rai 2018). There is a clear need for further research into systemic thrombolytics dosing and use.