Journal Club

Southwest Texas State Teachers College Debate Team 1928

Journal Clubs are not new in medical or science education, and the basic concepts have remained the same since the early 20th Century: communicate cutting edge research while teaching the participants how to critical assess the quality and utility of what they are reading.

In 2014, the Yale Department of Emergency Medicine overhauled it’s journal club format in order to try to better meet the needs of its faculty and residents, creating an annual curriculum where foundational emergency medicine research is placed in context along with fresh off the press findings. Check out the guidelines here. The starting point of this curriculum was the book, Emergency Medicine Evidence: The Practice-Changing Studies. Each month a classic article, often times from this book is paired with a related article from the current literature in order to gain a better understanding of our current practice patterns and where we are heading.

Journal Club Resources
Academic Journal Clubs Critical Appraisal Tools Evidence-Based Medicine
Annals Journal Club

Jackson Memorial Journal Club

Wash U. Journal Club

Statistics
Intro to Medical Stats

Statistics at Square One

CEBM Critical Appraisal Tools

CONSORT Guidelines

McMaster Evidence-Based Practice

User’s Guide to the Medical Literature

ALiEM

JAMA Rational Clinical Exam

Life in the Fast Lane

The NNT

YaleEM Underground Journal Club

Your patient:

 

43 y/o man on a statin, PMH HTN and gout, presents with abdominal pain, n/v in the setting of ingesting 100 tablets of XS Tylenol about 24 hours PTA.

 

What do you know about late presentations of acetaminophen toxicity?

 

This week Dr. David Hao will lead the discussion and review this rare prospective controlled toxicology paper by Keays et al.

This week we will look at two perspectives on contrast induced nephropathy (CIN).

We will focus on this brand new article (2017) and compare it to another with quite different findings from 2012.

The discussion will be led by Dr. Michael Yip.

Emergency Medicine Lectures will take place at Yale on Wednesday, January 25th beginning at 9:00am in TAC.

 

Tracheostomy

 

9:00 – 11:30 – ED GYN Complaints – D. Wood – TAC 205
9:00 – 11:30 – Journal Club – S. Marko, T. Melnick – TAC 207
9:00 – 11:30 – In Service Review – J. Bod – TAC 209

 

11:30 – 14:00 – The Trached Patient– O. Kovalerchik – TAC 205
11:30 – 14:00 – Smorgasbord Review – F. Moore – TAC 207
11:30 – 14:00 – Bedside Approach to the Domestic Violence Patient: SANE Kit – R. Harrison, T. Donovan – TAC 209

 

This is Resident Wellness Week so please join us at

464 Congress Ave. after lectures for lunch and cake.

 


Emergency Medicine Lectures will take place at Yale on Wednesday, January 11th beginning at 9:00am
obemergencies

 

9:00 – 11:00 – Toxicology AOC – Dr.Tomassoni – TAC 207
9:00 – 11:00 – Critical Care AOC – Dr. Wira – TAC 209
9:00 – 11:00 – Education/Simulation AOC – Sim Wars – Sim Center
9:00 – 11:00 – Public Health (Global Health) AOC – Healthcare and Physician Advocacy in the Age of Trump – Dr. Bernstein and Dr.Samuels – Harkness

 

11:15-11:30 – Admin Time – Mandantory Joint Comission Video – TAC 207

 

11:30 – 14:00 – PGY3 Talk – OB Emergencies – Dr. Shah – TAC 207
11:30 – 14:00 – Journal Club – Dr. Wood and Dr. Taylor – TAC 209
11:30 – 14:00 – Respiratory Emergencies – Dr. Baloescu – TAC 211

 

65 y/o F w/ history of HTN presents to your ED with dizziness that began yesterday when she got out of bed. Her symptoms worsen with head motion, she is nauseated, and has vomited several times. ROS is otherwise negative. Her exam is significant only for horizontal nystagmus in right lateral gaze.

 

Her symptoms moderately improved with oral medications, and she would like to go home.

 

Yet you are not convinced this is peripheral vertigo. “What you really want is a cheap, quick bediside test to differentiate central from peripheral vertigo.”

This Wednesday Dr. Iris Chandler will guide the discussion, looking at the HINTS exam paper (view here).

 

View background on the topic here.

What causes the veins to bulge in the hands and arms?

You’re not REALLY sure about that central line until, well, you really are….

 

Now you need time to set up. But your patient’s blood pressure is 60/30. Are you crazy to ask your nurse to start infusing norepinephrine through that nice 20 gauge in the patient’s arm?

 

This week Dr. Luke Whalen will guide the Journal Club discussion with a dive into this study by Cardenas-Garcia et al.

 

Click here for a relevant systemic review on the topic 

With 30 min left of your shift, you sign up for what you anticipate will be your last patient. Chief complaint: “abdominal pain.” You then realize this is way more challenging than you anticipated and that this is a frequent flyer who often presents with chronic non-specific abdominal pain. Extensive previous workups have all been negative. She is asking for only for “the drug with a ‘D'”.
Is anything else you can try for this patient? You recall one of your favorite attendings once using IV ketamine in a similar situation. Never having used ketamine for analgesia, you search the literature to find out if there is any data to support this choice.
This week Dr. David Ashkenasi will lead a discussion about the safety and effectiveness ketamine as compared to morphine for management of acute pain in the ED.
Primary article by Motov et al from 2015

 

 

Ever questioned the use of d-dimers for PE/DVT? Of course you have, if you’re in EM. For all those times you’ve wondered, this week Dr. Aman Shah will be leading an interesting discussion looking at “Saving Dimes and Sending Dimers”

 

 

For the time that 67 year old otherwise healthy woman comes in slightly short of breath and slightly tachy, making you worried about PE, but has no risk factors… Should you trust her age-adjusted D-dimer cutoff?

Righini, M., et al. (2014). “Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study.” JAMA 311(11): 1117-1124.

 

And when the thought didn’t initially cross your mind, but only later you wondered about PE in this lady, does re-sticking a patient increase the circulating d-dimer value? Read on, what do you think?

Heffner, A. and J. Kline (2001). “Role of the peripheral intravenous catheter in false-positive D-dimer testing.” Acad Emerg Med 8(2): 103-106.

 

Something extra to make you rethink ordering that extra blue top just in case…

Kochert, E., et al. (2012). “Cost-effectiveness of routine coagulation testing in the evaluation of chest pain in the ED.” Am J Emerg Med 30(9): 2034-2038.

What would you do in this case?

older-man-coughing
58yo m h/o HTN presents with 3 days of high fevers and productive cough. He’s a reasonable but not outstanding protoplasm, but he looks sick. Temp 102.4, HR 110, BP 115/82, satting 92%. He doesn’t drink or smoke. He has decreased LLL sounds, his CXR has a REAL consolidation. You give abx, you decide to admit, you fluid resuscitate and treat that fever, BUT…. do you give roids???

 

What do you think after reading this week’s article?

 

This is an interesting question also being discussed in the FOAMed world.

 

Dr. Melissa Hazlitt is leading an awesome journal club this week! Comments for discussion welcome.

 

 

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