Dr Scheuermeyer and the reasearch group have recently published the validation of our beloved Chest Pain Pathway, in the Annals of Emergency Medicine.

This paper has the potential to change practice in EDs around the world, though as Dr Scheuermeyer can attest, there is significant resistance to the ideas presented in the paper especially with our American colleagues.

This paper has already been integrated into some high profile medical sites, being referenced in the Medscape Acute Coronary Syndrome article; is featured in Journal Watch; and garners a review by Ryan Radecki of the excellent EM Lit of Note Blog (follow on the blog and on Twitter - highly recommended).

The article can be found on:

PubMed PMID:22221842 (use this if you are at work or use UBC myVPN from home)

The Annals Website (use this if you have direct access to the journal online)

This is a post I have been meaning to write for over a year.  I recently discovered a trove of useful videos and documents about the EZ-IO, so it appears that the time is right.

I have used the EZ-IO a few times, with mixed success despite its reputation as being near idiot proof...

I am also fascinated by how squeamish people are with the idea of using a small needle well away from anything 'vital' (the IO), compared to using a 3-4 inch needle in and around someone's neck or groin...

So, here for your edification and mine, the EZ-IO Learning Primer:

Basic points:

1. Can only stay in for 24 hours.

2. Still have to use sterile technique (just sayin')

3. Can infuse just about anything that can go in a peripheral line (limit hypertonic saline to 30 min or less)

There is a 30 minute online Learning Tool here (you need to provide some info to be allowed in - name and where you work).  It goes over pretty much everything you need to know, including Lab test correlations.  You can navigate to individual slides if you want the Coles Notes version

The EZ-IO Training Page - this video is a long and cheesy ad, but a decent overview.

Only 2 of the PDFs listed in the side bar on the Training Page are of any use, and they both focus on the tibial plateau insertion: 1. How to Insert and Remove the System  2. Needle Sets Overview.

Much better are the YouTube videos:

The first 2 I will highlight are like the one on the Training Page - cheesy acting and music, but they cover both the Tibial and Humeral Insertiion techniques.

The next 3 are demos on real people (medical staff during their Haiti earthquake relief mission)

Next, learn from the mistakes of others.  YouTube superuser and Emergency Medicine junkie lmellick (160 videos - go look now, I'll wait) posts '6 Mistakes in Awake Adult IO Infusion'

Finally, if you need some flashy animation for a presentation, use this one (no Audio).

Dr Stephen Smith (University of Minnesota) is an Emergency Physician at Hennepin Medicial Centre.  He runs the most excellent Dr Smith's ECG Blog, a MUST READ Emergency Medicine Blog.

He and his colleagues have just published, in Annals of Emergency Medicine, an interesting article:

Electrocardiographic Differentiation of Early Repolarization From Subtle Anterior ST-Segment Elevation Myocardial Infarction

They have derived and validated a formula to aid in this often difficult situation.

Come on Cardiac & Research geeks, let us know what you think.

Leon Gussow at The Poison Review points us to a 'superb' review of toxicological antidotes.  Read his take on this review here (please read this as he makes important points about specific areas of the article), and then leave you thoughts in the comments.

You can find the original here.

In what I hope is not a vain attempt to make the site more useful and interactive, I will be featuring a variety of Emergency Medicine related articles.  I hope that many/some of you will read these articles.  Further, I hope that some/a few of you will take the time to login to the site and contribute your thoughts/concerns/critiques in the comments for each article.

The articles will be linked to via the UBC Library eLink.  This should work from within the hospital (theoretically).  If there are problems getting to the article, please let me know at <admin AT sphemerg DOT ca>