Latest Critically Appraised Topics (CATS)

Below and in the Previous JC Topics link you will find a host of CATS that provide the best evidence available about various topics. These CATS have been presented at our monthly Emergency Medicine Journal Club by our residents at the EVMS emergency medicine residency program. Feel free to forward any comments or suggestions you may have.(mail)

December 2009: JC gets a pass for the Christmas New Year Holiday. We will be looking at some formatting changes coming soon so keep the ideas & suggestions coming. Have a great holiday season! 

November 2009

Is there a role for steroids in patients with acute pharyngitis?

Bell's Palsy: Does the use of antivirals provide any additional benefits?

Outcomes Feedback:  A thought provoking open access essay:  Is no news bad news?     

October 2009

A decision rule for kids with minor head injury: PICARN   Abstract

Is the combination of ketamine and propofol (Ketofol) a useful adjunct in pediatric ED sedation?

 

September 2009

Is there a role for Rapid Flu-Testing in the Emergency Department? 

Antivirals and Flu-like illness: Is there any evidence to support their routine use?  

Efficacy of H1N1 Monovalent Vaccine: A Preliminary Report     abstract

August 2009

Glycemic control in the ICU patient: an appraisal of the NICE-SUGAR trial.  

Is there a role for vasopressin in the treatment of septic shock?

Early goal directed therapy: A look back & critical appraisal of the original Rivers article.

July 2009

Should Thiamine be used in the routine management of the chronic ETOH abuser?

Is there a role for ASA plus clopidogrel in acute ischemic stroke and TIA?

June 2009:  JC Takes a break as we bid adieu  to the Class of 2009 and ready ourselves for the 'newbies.'

May 2009 JC made a visit to SAEM in NOLA and two of our resident presenters offer up abstracts of interest. One sadly stayed behind and presented the PICO below

The Sellick maneuver...useful,  or a hindrance to ED intubation?

Dr.Stewart's Abstracts of interest from the Annual SAEM Meeting

April 2009

Shoulder dislocations...should all reductions begin with the use of intra-articular anesthetics?

Should we be Pan-Scanning ALL blunt abdominal trauma patients?

Validation of a universal rule for pre-hospital termination of resuscitation

March 2009

GI Bleeds: Can Octreotide/Somatostatin be useful in ED patients with acute NON-variceal GI Bleeding?

Hematemesis: Is there a useful prediction tool for identifying patients who can be safely discharged from the Emergency Department

Variceal Bleeding: Emergent endoscopy vs. octreotide & vasopressin. Is there a better choice?

Do NG tubes provide any utility in triaging patients suspected of having upper GI bleeds?

February 2009

Fever in ages 3-36 months...Do well appearing kids need anything other than a U/A

MMWR report on the impact of polyvalent pneumococcal vaccine Prevnar

Elbow Extension Test for Acute Fractures: A new clinical prediction tool...ready for prime-time or not?

The SWEET Study for Acute Elbow Fractures

Is C-reactive Protein a useful adjunct in evaluation ED patients with acute chest pain?

 

January 2009

Skin abscesses, MRSA or not: Is there any evidence in support of empiric antibiotics?

Vertigo: The Epley maneuver vs. benzodiazepines, anticholinergics or antiemetics?  (link to The Epley)

Hypertonic Saline in Acute Bronchiolitis: A Critical Appraisal of an RCT

December 2008

JC gets a pass for the holidays. We will be back with new topics in January and always welcome suggestions for clinical questions. Take a look at the new voluntary PhRMA rules that go into effect January 1st. We'll avoid any commentary at this time and suggest you take a look and start stocking up on your pens. Have a great holiday.

PhRMA Code of Interaction with Healthcare Professionals

November 2008

Can TPA be given safely six hours after onset of an acute ischemic CVA?

The ABCD2 prediction rule for patients with TIA

Thrombectomy in acute CVA...ready for prime time or not?

October 2008

Can Serum Tryptase Serve as a Biomarker for Those Predisposed to Anaphylaxis?

Do Narcotic Analgesics  impact the Accuracy of the Physical Exam in  Children with Acute Abdominal

Pain?

September 2008 - ELECTION 2008 This month JC took a look at the Presidential Candidates positions on healthcare. Below are our presenters summaries. 

Obama's Healthcare Plan Summary 

McCain's Healthcare Plan Summary 

Ron Paul's Healthcare Plan Summary 

August 2008

Hypotensive Resuscitation in Trauma: Slow fluids, no fluids or get out the pressure bags

Sodum Bicarbonate in Sepsis: Still crazy after all these years

Emergency Department Coronary CT-A: A new "gold standard"?

July 2008

Emergency Department Coronary MRI: Ready for prime time or not?

Contrast Induced Nephropathy: An update on fluids, NAC or sodium bicarbonate?

Critical Appraisal: Morphine, Ketorolac or both in acute renal colic?

June 2008...JC gets a pass this month as we bid adieu to our seniors and  prepare for the newbies. Take a look at the recent postings in the essay and article section. We want to thank all for getting us to 10,000 unique visitors on 4 June.

May 2008

Is oral contrast for CT necessary when evaluating patients with acute blunt abdominal trauma?

What's the evidence in support of using hypertonic saline in the acute head injured patient?

Is the re-packing of cutaneous abscesses cruel and unusual punishment?

April 2008

Is enoxaparin (Lovenox) as effective as unfractionated heparin in those patients with  acute  pulmonary embolism?

Critical Appraisal: The Interact Trial  Should we be more aggressive about lowering systolic blood pressure in those with acute ischemic stroke?   (Interact Trial Lancet Neurol. 2008 Apr 4)

Critical Appraisal: The Unload Trial  Is ultrafiltration of utility in ED ptients with acute CHF? (The UNLOAD Trial J Am Coll Cardiol 2007; 49:675-83)

March 2008

Steroids in Sepsis: What's the evidence in support of empiric use of steroids in the septic ED patient?

Rapid Flu Testing: Is there an appropriate role for testing in the ED

Critical Appraisal: Predicting outcome after traumatic brain injury: practical prognostic models based on  a large cohort of international patients. MRC Crash Trial Collaborators    article BMJ 2008 Feb 23;336(7641):425-9

February 2008 

JC elected to play nice in view of the In-Service exam and attending's presented the following topics and articles.

The Full Moon and Emergency Department Visits: A howlingly good PICO by Dr. Lo appears to finally put the question to sleep.

Hemostatic/Thrombotic Agents: Are these agents ready for prime-time in the ED or should they be reserved for those in the battlefield?

Can Magnesium Sulfate be used safely and effectively for rate / rhythm control in atrial fibrillation?

January 2008

Can B-Blockers be used safely in cocaine abusers with chest pain due to ACS?

Is the CRP or Procalcitonin a better indicator for infection than the White Blood Cell Count?

In acute CHF, can B-blockers be considered a safe and effective adjunct  to  typical  measures?

December 2007  JC gets a pass for the Holidays. Here's a few holiday reads. Enjoy.            

On Happiness: So money's not the answer after all 

Art of Medicine: On admitting patients without discernable pathology (PWDP)

November 2007

Can ED OBS patients safely undergo accelerated serial enzyme determinations?

Critical Appraisal: Steroids vs. Acyclovir for Bell's Palsy?

NEJM Article Bell's Palsy

Is CT of the C-spine in the multi-trauma patient sufficient or is MRI necessary ?

October 2007

Is Insulin Effective in Ca Channel Blocker Overdose? 

How About Nebulized Mg in Acute Asthma?

Factor VII in Acute Intracranial Hemorrhage: A Critical Appraisal     Original NEJM Article 

September 2007

Should We be Using Absorbable Sutures More Frequently?

Canadian vs. New Orleans Head CT Rules - original articles can be found in clinical tools section         

Hespan vs. Crystalloid for Fluid Resusciation 

August 2007 

Is D-Dimer Useful for Diagnosing Thoracic Aneurysm?  

Is Ultrasound Assistance for IJ Central Lines Preferred Over Landmark Techniques?

Is NAC Effective in Preventing Contrast Induced Nephropathy?  

July 2007

Are Early Thrombolitics Indicated in Submassive PE?

Do Pre-Intubation Steroids Decrease Laryngeal Edema? 

June 2007- JC Takes a vacation!

 May 2007

Treating Pneumonia...The 4-hour "Rule"

Should Skin Abscesses be Rx'd with Antibiotics for MRSA? 

Are False Positive Troponins Common in Renal Failure? 

April 2007 

Should Kids with Cephalohematomas Undergo Head CT?  

Is Lidocaine Necessary for RSI in Head Injury? 

Should Steroids Be Used Early in Suspected Meningitis Cases?  

March 2007

Is Etomidate Safe In Septic Shock? 

How Does MRI compare to CT for Acute Stroke 

How Does Coronary CT-A Compare to Stress Echo? 

February 2007

Should we be core cooling post-resuscitation patients? 

Are topical anesthetics effective for parenteral procedures? 

Does counseling regarding inappropriate ED visits work?

January 2007 

Are Serial Lactic Levels Useful When Managing Sepsis? 

Intra-articular Anesthetics Prior to Shoulder Reduction  

Ketamine vs. Etomidate for Pediatric Conscious Sedation