Thank You ALiEM Expert Peer Reviewers

ExpertPeerReviewStamp2x200We would like to take this opportunity to thank those of you who took the time to take part in our exciting new Expert Peer Review series over the last 4 months of 2013.  Your contributions helped us roll out this ground breaking process, and we hope you all will continue to contribute to our peer review in the future. 


Carbon Monoxide Poisoning: Common Questions and Dilemmas

Carbon monoxideExpertPeerReviewStamp2x200Carbon monoxide (CO) is an odorless, colorless gas and is one of the most common causes of unintentional poisoning deaths in the United States. It is also one of the most common p­oisoning presentations to Emergency Departments. Because CO is produced by the incomplete combustion of carbon-containing fuels, the incidence of accidental exposure peaks during the winter months due to increased use of in-door heating sources and reduced ventilation. 1–3  Several management dilemmas commonly arise when dealing with patients with potential CO poisoning.


Mechanical CPR and the LINC trial


ExpertPeerReviewStamp2x200The first time I saw the Thumper performing CPR on a patient I thought “well, that makes sense.” Since then we have seen other devices, most notably the Zoll AutoPulse and the Physio-Control LUCAS. It was disappointing to many in 2005 when the AutoPulse trial was halted early due to harm. 1 Although four-hour survival was similar between groups, the hospital discharge survival rate in the manual CPR group was 9.9% compared to 5.8% in the mechanical CPR group. Many hypotheses were proposed to explain the results, which included Hawthorne effect, prolonged device deployment time, and enrollment bias. Last month, the results of the LUCAS in Cardiac Arrest (LINC) trial were published in JAMA, breathing new life into the mechanical vs manual CPR debate. 2


Shock Index: A Predictor of Morbidity and Mortality?

a_11Emergent airway management and severe sepsis are both high-risk situations that are commonly encountered by emergency physicians. It is well known that complications can be high in both situations, which in turn can lead to increased morbidity and mortality. For instance, about 1/4 of patients who are hemodynamically stable prior to intubation get post-intubation hypotension (PIH) after rapid sequence intubation. Also septic patients may not be reliably identified by systemic inflammatory response syndrome (SIRS) markers early in their disease course. The Shock Index (SI) may be an adjunct that is easy to calculate and could predict both PIH and severe sepsis.


ALiEM Journal Club Question 1: Bias

Screen Shot 2013-11-17 at 3.36.12 PMExpertPeerReviewStamp2x200For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 1 on the topic of bias:

The authors use distinct methods for tallying computed tomography (CT) use in the 2 countries. List the biases that could occur in counting CTs by each method.


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