Mechanical CPR and the LINC trial

lucas

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

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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.

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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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Thyroid Storm: Treatment Strategies

T3hyperExpertPeerReviewStamp2x200The Case

You have a 54-year-old female who presents to the emergency department with a chief complaint of “just feeling out of it.” She has felt “off and on” for the past 12 hours and has had an occasional cough with some sputum production along with “the shakes and chills.” She also feels as if her heart was “going at a mile a minute” and because of this, she is very much out of breath.

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Discussing Annals EM article: Social Media and Physician Learning

SoME and Physician learningExpertPeerReviewStamp2x200I was delighted to see the News and Perspectives piece in this month’s Annals of Emergency Medicine about “Social Media and Physician Learning” (free PDF). I had totally forgotten that Jan Greene, the author, had called to talk with me several months ago. In the piece, she discusses many of the issues with which I struggle:

  • Is peer review good or bad?
  • What is the role of blog and podcast sites in the future of medical education?
  • With the ease of how anyone can be “published” on blogs, how can one decide on the trustworthiness of open educational resources such as FOAM?
  • Can or should social media education practices be held up to the rigorous scientific standards of original research?

Here are some noteworthy quotes:

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