Another trial of prehospital plasma for trauma (COMBAT)

A brief summary of the COMBAT trial looking at prehospital plasma for trauma resuscitation.

A couple weeks ago I covered the PAMPer trial, which demonstrate a potentially “unbelievable” 10% decrease in mortality by using plasma as the primary resuscitation fluid prehospital in trauma patients being transferred by air. I was somewhat skeptical (surprising I know) of the result. This is a similar study, but with different conclusions.

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IV fluid choice part 3: The SALT-ED trial

A review of the SALT-ED trial (Self 2018) comparing 0.9% saline to balanced IV fluids in an emergency department setting

So far, this week’s discussion of IV fluid choice has focused on ICU patients in our discussion of both the SPLIT and SMART trials. I work in the emergency department and really want to know how to manage emergency department patients. To close out IV fluids week, we will look at the SALT-ED trial, which was run by the same group and at the same hospital group as the SMART trial, but focused on patients in the emergency department.

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IV fluid choice part 2: The SMART trial

A review of the SMART trial (Semler 2018) comparing 0.9% saline to balanced crystalloid

Yesterday, I covered the SPLIT trial, comparing saline with Plasma-Lyte 148. Today we are going to look at SMART, the trial that provoked the numerous cringe-worthy popular headlines…

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IV fluid choice part 1: The SPLIT trial

A review of the SPLIT trial (Young 2015) comparing saline to Plasma-Lyte 148

“The saline used in IV bags could be killing you”, screams the New York Post. CNN seems to agree. Everyone in the world seems to know that saline is evil, but just yesterday I hung a bag of normal saline when treating a sick septic patient. Is that because I am a bad doctor? Because I haven’t read the studies? Because I don’t care? Or is this just another example of the general rule that headline news describing medical research is almost always wrong?

Those headlines were in response to two studies published in the New England Journal this year: SMART and SALT-ED. I will get to those papers in the next 2 days, but I think we should start with what was previously the largest, and still is the best trial available comparing saline to a balance IV solution. Welcome to IV fluids week…

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Adverse drug reactions in the emergency department (Hohl 2018)

Can a decision tool help us identify patients at risk for adverse drug reactions in the emergency department?

Adverse drug events might be responsible for as many as 1 in 9 emergency department visits.1,2,3 Physicians frequently miss the diagnosis of medication related adverse events.4,5,6 Pharmacists can be very helpful in assessing patients for adverse drug events, but are a scarce or non-existent resource in most emergency departments. This paper asks whether clinical decision tools can help us identify adverse drug reactions among emergency department patients.

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Paramedic 2: Epinephrine harms/helps in out of hospital cardiac arrest

A critical appraisal of the PARAMEDIC 2 trial (epinephrine in out of hospital cardiac arrest)

After years of waiting, PARAMEDIC 2, the large RCT of epinephrine for out of hospital cardiac arrest, has finally been published. So we can now definitively say that epinephrine is harmful. Wait, maybe it helps? Can a positive study demonstrate harm? Maybe this EBM stuff isn’t so easy after all

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Articles of the month (July 2018)

A monthly (ish) summary of the emergency medicine literature

You will probably notice a new format to the articles of the month. I was getting sick of not being able to find papers that I knew I had previously commented upon. Having them listed as one 10 papers in the articles of the month made them very difficult to search for. Therefore, on bigger, more important papers, I have started writing stand alone blog posts. I will still include those papers in the articles of the month, but the summary will be truncated, with a link to the blog for all the details. The articles of the month will probably still contain extra articles, including papers that don’t warrant their own post and my usual “just for fun” kind of papers. Let me know what you think. Continue reading “Articles of the month (July 2018)”