Episode 97 EM Literature Review 2016 from EMU & Whistler Conferences

In this episode on EM Literature Review 2016, Joel Yaphe, Justin Morgenstern and Jason Fischer provide quick and insightful reviews of 17 important adult and pediatric emergency medicine studies from 2016: The PROCAMIO study for stable VT, platelets for head bleeds (PATCH), BP lowering in ICH (ATACH II), antibiotics for abscesses, work up of subarachnoid hemorrhage, dosing IV ketorolac, the PESIT trial, ketamine dosage for sedation in pediatrics, instructions after minor head injury, Salter-Harris I fractures of the lateral malleolus, interpreting oxygen saturation for disposition making in children with bronchiolitis, clinical pathways in pediatric asthma and sepsis and more! These talks were given at North York General Hospital’s Emergency Medicine Update in Toronto and the University of Toronto’s Update in EM Conference - Whistler. Podcast production and sound design by Anton Helman. Written Summary and blog post by Keerat Grewal, edited by Anton Helman June, 2016 Cite this podcast as: Helman, A, Yaphe, J, Morgenstern, J, Fischer, J. EM Literature Review 2016 from EMU & Whistler Conferences. Emergency Medicine Cases. June, 2016. https://emergencymedicinecases.com/episode-99-highlights-emu-2017/. Accessed [date]. 1. What is the safety and efficacy of IV procainamide compared to IV amiodarone in treating stable ventricular tachycardia? The PROCAMIO Study Background: Current guidelines include procainamide and amiodarone as class II recommendations for the management of stable VT. There is no evidence to support the benefit of one treatment over the other. Ortiz M, Martin A, Arribas F, et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur H Journ. 2016;38(17):1329-35. The Study: Multi-center, open-label, RCT of 62 patients in Spain. Compared procainamide 10mg/kg IV over 20 minutes versus amiodarone 5mg/kg IV over 20 minutes. Followed for 40 minutes after the start of infusion for termination of dysrhythmia and major cardiac events. Results: Major cardiac events in patients who received procainamide was 9% versus 41% in patients who received amiodarone. Amiodarone was less effective in terminating dysrhythmia. Conclusions: Procainamide therapy was associated with fewer major cardiac events and a higher proportion of tachycardia termination compared to amiodarone. Issues: * Small sample size * In Spain, patients with stable VT can be treated in the prehospital care setting, therefore, patients may have been missed if they converted in the prehospital setting. * The dose of amiodarone used in the study is higher than what is currently recommended for the treatment of VT in guidelines. This could contribute to the increased number of side effects seen with amiodarone. Take Home Message and Expert Commentary: This study provides compelling evidence that procainamide is safer and more effective in terminating stable VT compared to amiodarone. Do not forget that electrical cardioversion is also an option. In the stable patient, use shared decision making and discuss the available options with the patient.   2. Does platelet transfusion with standard care compared to standard care alone reduce death or dependence after intracerebral hemorrhage (ICH) in patients taking antiplatelet agents? The PATCH study Background: Patients with intracerebral hemorrhage who are on antiplatelet therapy have worse outcomes. In theory, it is thought that platelet infusions in patients wit...