Classic EM Journal Reviews

Prospective Validation of the HEART Score

Chest pain representing acute coronary syndrome (ACS) is the most common reason patients presenting to the emergency department (ED) are admitted to the hospital. The treatment for ACS is early targeted therapy and missed cases results in increased morbidity and mortality. As a result many clinicians choose to admit patients for further evaluation, resulting in further testing and higher medical costs.
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Tags: , December 8th, 2016 Leave a Comment

Canadian Head CT Decision Tool

CT scans are frequently done after minor head injury to evaluate for intracranial hemorrhage. While CT scans are an excellent tool for diagnosing or ruling out this disorder, they are not without harms including radiation exposure, cost and department delays. Much of the time, CTs are negative, or find injuries for which no intervention is ever done and do not clinically affect the patient.
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Ottawa Ankle Clinical Decision Instrument Derivation Study

Prior to the creation of the Ottawa Ankle Decision Instrument, most patients presenting to the Emergency room with a complaint of acute ankle injury had ankle and or foot radiographs ordered to evaluate for fracture, even though the incidence of fracture among this population is relatively low (~ 15%). While ankle radiographs do not expose the patient to large amounts of radiation,
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Tags: , , August 25th, 2016 2 Comments

NEXUS C-Spine Decision Instrument

Neck pain after blunt trauma is common but significant cervical spine injuries are not. An unrecognized cervical spine injury can be catastrophic as it can lead to serious neurologic disability or even death. As a result, we as clinicians are fairly liberal about performing imaging of the cervical spine after trauma. Prior to the creation of the NEXUS C-spine criteria and the Canadian C-spine criteria,
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Tags: , , August 18th, 2016 Leave a Comment

NINDS – tPA in Ischemic Stroke

Each year, 22 million people worldwide will experience a stroke. 50% of these are ischemic strokes. For years, there were no effective treatments for these patients. As a result, the burden of ischemic stroke was enormous. Patients often experience debilitating strokes requiring round-the-clock care. Acute ischemic strokes represent the leading cause of disability in our society and the third most common cause of death.
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Tags: , September 24th, 2015 Leave a Comment

Ottawa Aggressive Atrial Fibrillation Protocol

Atrial fibrillation (AF) is one of the most common dysrhythmias encountered in the ED. Patients with chronic AF often present with increased heart rates, chest pain and weakness among other presentations. However, it’s the patients with new onset AF that really peak our interest. Why? Well, the management of these patients is potentially exciting, filled with procedures and clearly debatable.
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Tags: , , July 16th, 2015 Leave a Comment

CRASH-2: Tranexamic Acid in Major Trauma

Injuries are a major cause of death worldwide. Millions of people die every year from traffic injuries. In fact, they are the 9th leading cause of death around the world. Additionally, another 1.5 million people die every year from interpersonal violence. Hemorrhage accounts for about 1/3 of all trauma deaths and as such, it should be our goal to find treatments to decrease death from hemorrhage.
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Tags: , April 23rd, 2015 Leave a Comment


Sudden cardiac arrest is common and, obviously, very bad. In the US, there are about 500,000 cardiac arrests each year. About half of these cardiac arrests are out of hospital cardiac arrest (OHCA) and the survival rate is pretty poor. The most recent survival estimates put it at 7 – 9.5% in most communities.
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