Journal Jam Podcast

$regional nerve block for hip fractures$

JJ 13 Regional Nerve Blocks for Hip Fractures

In this EM Cases Journal Jam podcast with Anton Helman, Justin Morgenstern, Rory Spiegel, and special guest Jacques Lee we explore the evidence for femoral nerve blocks and fascia iliaca blocks as well as discuss the practical implementation of them in your ED. We answer questions such as: Do regional nerve blocks for hip fractures effectively reduce pain? Do they decrease opioid use? Are they safe compared to standard pain management? Should the block be done prior to x-ray confirmation? and many more...

By Anton Helman|2023-05-14T18:17:47-04:00August 28th, 2018|Categories: EM Cases, Emergency Medicine, Journal Jam, Medical Specialty, Orthopaedics, Trauma|Tags: Dr. Jaques Lee, fascia iliaca block, femoral nerve block, hip fracture, journal jam|1 Comment

JJ 12 BNP for Diagnosis of Acute CHF

BNP is currently in use in many EDs across North America and Europe. In this Journal Jam podcast we discuss the clinical utility of BNP and pro-NT-BNP in the work-up of the dyspneic ED patient. We ask the questions: does BNP add much beyond physician gestalt? Which patients might BNP be useful for? Should we abandon BNP as a dichotomous rule-in/rule-out variable and instead use it as a continuous variable? Does using BNP effect patient oriented outcomes? Is lung POCUS a better test? Are prediction models that include BNP useful? and many more....

By Anton Helman|2019-01-01T18:12:01-05:00March 13th, 2018|Categories: Cardiology, EM Cases, Emergency Medicine, Journal Jam, Medical Specialty|Tags: acute heart failure, BNP, Brian Steinhart, CHF, Chris Carpenter, spectrum bias|3 Comments

Journal Jam 11 Post Contrast Acute Kidney Injury – PCAKI

Lauren Westafer joins Justin Morgenstern, Rory Spiegel and Anton Helman in a deep dive discussion on the world's literature on Post Contrast Acute Kidney Injury (PCAKI) in this Journal Jam podcast. Hospitals continue to insist on time consuming, and potentially dangerous protocols for administration of fluids to patients with renal dysfunction prior to CT IV contrast despite the lack of evidence that Contrast Induced Nephropathy (CIN) even exists. Would you choose a different imaging modality if your radiologist suggested that a patient with renal dysfunction who required a CT with IV contrast should forgo the contrast risking a missed diagnosis?

By Anton Helman|2023-05-14T18:19:36-04:00November 21st, 2017|Categories: EM Cases, Emergency Medicine, Genitourinary, Journal Jam, Medical Specialty|Tags: contrast induced nephropathy, IV contrast, Lauren Westafer, PCAKI|0 Comments

Journal Jam 10 Part 2 Endovascular Therapy for Stroke

In this part 2 of EM Cases Journal Jam podcast on Thrombolysis and Endovascular Therapy for Stroke Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on endovascular therapy for stroke. While the evidence for endovascular therapy is stronger than that for IV systemic thrombolysis for stroke outcomes at 90 days, a closer look at the literature reveals that a very small minority of patients are eligible for endovascular therapy and we still don't know which patients benefit most from endovascular therapy...

By Anton Helman|2018-12-21T19:08:04-05:00July 4th, 2017|Categories: EM Cases, Emergency Medicine, Journal Jam, Medical Specialty, Neurology|Tags: ESCAPE, journal jam, Justin Morgenstern, MR CLEAN, Rory Spiegel, SWIFT PRIME, THRACE|3 Comments

Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1

In this two part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke. We elucidate the important issues related to p-values, ordinal analysis, fragility index, heterogeneity of studies, stopping trials early and conflicts of interest related to this body of evidence. While "calling a code stroke" is now considered standard for most stroke patients and tPA for stroke is considered a class 1A drug, a close look at the literature tells us that the evidence is not as strong as our stroke protocols suggest...

By Anton Helman|2022-05-03T21:31:49-04:00July 4th, 2017|Categories: EM Cases, Emergency Medicine, Journal Jam, Medical Specialty, Neurology|Tags: CVA, ECASS-3, fragility index, Justin Morgenstern, NINDS, Rory Spiegel, tPA|6 Comments

Journal Jam 9 – D-dimer to Rule Out Aortic Dissection

The EM Cases Team is very excited to bring you not only a new format for the Journal Jam podcast but a new member of the team, Dr. Rory Spiegel, aka @EM_Nerd an Emergency Medicine physician from The University Maryland Medical Center in Baltimore, the founder of the EM Nerd blog and the co-host of the Annals of EM podcast. The new format sees Justin Morgenstern, Teresa Chan, Rory Spiegel and Anton Helman doing deep dives into the world's literature on specific practical questions while highlighting some important evidence-based medicine concepts. The question we ask in this Journal Jam podcast: Is there a role for D-dimer testing in the workup of aortic dissection in the ED?

By Anton Helman|2018-12-21T19:15:51-05:00February 7th, 2017|Categories: Cardiology, EM Cases, Emergency Medicine, Hematology, Journal Jam, Medical Specialty|Tags: ADD score, aortic dissection, D-dimer, EBM, Justin Morgenstern, Rory Spiegel, spectrum bias, Teresa Chan|1 Comment

Journal Jam 8 – Dilute Apple Juice for Pediatric Gastroenteritis

This is EM Cases Journal Jam podcast on a randomized control trial of dilute apple juice vs PediaLyte for mild pediatric gastroenteritis. While IV rehydration is required in cases of severe gastroenteritis (which we rarely see in North America) and oral rehydration with electrolyte maintenance solutions is still the mainstay in treating moderate gastroenteritis, could better-tasting, more cost-effective fluids such as diluted apple juice be just as effective as traditional electrolyte solutions in milder cases? Listen to Dr. Justin Morgenstern (@First10EM) interviewing Dr. Stephen Freedman, the world-renowned pediatric EM researcher who put ondansetron for pediatric gastroenteritis on the map and who was one of our guest experts on our main episode on Pediatric Gastroenteritis, Constipation and Bowel Obstruction, about this practice-changing paper. This is followed by a hilarious rant on the topic from Dr. Anthony Crocco ("Ranthony"), the Division head and medical director of pediatric EM at Hamilton Health Sciences.

By Anton Helman|2018-12-21T19:20:46-05:00November 8th, 2016|Categories: EM Cases, Emergency Medicine, Gastroenterology, Journal Jam, Medical Specialty, Pediatrics|Tags: Anthony Crocco, dehydration, gastroenteritis, Justin Morgenstern, pediatlyte, Stephen Freedman|1 Comment

Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial

Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial. In our most popular EM Cases episode to date - ACLS Guidelines Cardiac Arrest Controversies, we boldly stated, that there has never been an antiarrhythmic medication that has shown any long term survival benefit in cardiac arrest. The use of medications in cardiac arrest has been one of those things that we all do, but that we know the evidence isn’t great for. Yet Amiodarone is still in the newest AHA adult cardiac arrest algorithm for ventricular fibrillation or pulseless ventricular tachycarida – 300mg IV after the 3rd shock with the option to give it again at 150mg after that. Anti-arrhythmics have been shown in previous RCTs to increase the rate of return of spontaneous circulation and even increased survival to hospital admission, however none of them have been able to show a decrease in mortality or a favourable neurological outcome at hospital discharge. In other words, there has never been shown a long term survival or functional benefit - which is a bit disconcerting. But now, we have a recent large randomized, controlled trial that shines some new light on the role of anti-arrythmics in cardiac arrest - The ALPS trial: Amiodarone vs Lidocaine vs placebo in out of hospital cardiac arrest. In this Journal Jam podcast, Justin Morgenstern and Anton Helman interview two authors of the ALPS trial, Dr. Laurie Morrison a world-renowned researcher in cardiac arrest and Dr. Paul Dorian, a cardiac electrophysiologist and one of Canada's leading authorities on arrhythmias about what we should take away from the ALPS trial. It turns out, it's not so simple. We also discuss the value of dual shock therapy for shock resistant ventricular fibrillation and the future of cardiac arrest care.

By Justin Morgenstern|2020-05-31T23:25:17-04:00July 26th, 2016|Categories: Cardiology, EM Cases, Emergency Medicine, Journal Jam, Medical Specialty, Resuscitation|Tags: ALPS trial, amiodarone, cardiac arrest, Laurie Morrison, lidocaine, Paul Dorian|2 Comments

Journal Jam 6 – Outpatient Topical Anesthetics for Corneal Abrasions

This is EM Cases Journal Jam Podcast 6 - Outpatient Topical Anesthetics for Corneal Abrasions. I’ve been told countless times by ophthalmologists and other colleagues NEVER to prescribe topical anesthetics for corneal abrasion patients, with the reason being largely theoretical - that tetracaine and the like will inhibit re-epithelialization and therefore delay epithelial healing as well as decrease corneal sensation, resulting in corneal ulcers. With prolonged use of outpatient topical anesthetics for corneal abrasions, corneal opacification could develop leading to decreased vision. Now this might be true for the tetracaine abuser who pours the stuff in their eye for weeks on end, but when we look at the literature for toxic effects of using topical anesthetics in the short term, there is no evidence for any clinically important detrimental outcomes. Should we ignore the dogma and use tetracaine anyway? Is there evidence that the use of topical anesthetics after corneal abrasions is safe and effective for pain control without adverse effects or delayed epithelial healing? To discuss the paper "The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review" by Drs. Swaminathan, Otterness, Milne and Rezaie published in the Journal of Emergency Medicine in 2015, we have EM Cases’ Justin Morgenstern, a Toronto-based EM Doc, EBM enthusiast as well as the brains behind the First10EM blog and Salim Rezaie, Clinical Assistant Professor of EM and Internal Medicine at University of Texas Health Science Center at San Antonio as well as the Creator & Founder of the R.E.B.E.L. EM blog and REBELCast podcast. In this Journal Jam podcast, Dr. Morgenstern and Dr. Rezaie also discuss a simple approach to critically appraising a systematic review article, how to handle consultants who might not be aware of the literature and/or give you a hard time about your decisions and much more...

By Anton Helman|2019-11-11T15:55:23-05:00March 29th, 2016|Categories: EM Cases, Emergency Medicine, Journal Jam, Medical Specialty, Ophthalmology|Tags: corneal abrasion, Justin Morgenstern, Salim Rezaie, systematic review, tetracaine, topical anesthetics|0 Comments

Journal Jam 5 One Hour Troponin to Rule Out and In MI

Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI. The paper we'll be discussing here is a multicentre/multinantional study from the Canadian Medical Association Journal from this year out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardian troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour but whether or not we can expedite the ruling in of MI using this protocol.

By Anton Helman|2020-05-31T23:22:44-04:00December 22nd, 2015|Categories: Cardiology, EM Cases, Emergency Medicine, Journal Jam, Medical Specialty|Tags: Andrew Worster, Justin Morgenstern, myocardial infarction, troponin|1 Comment