Evidence-Based Medicine

Study: Using NIPPV for Acute Cardiogenic Pulmonary Edema Can Save Lives

by Suneel Upadhye, MD, MSc on January 18, 2010

The use of non-invasive positive pressure ventilation (NIPPV), especially CPAP, in decompensating patients with acute cardiogenic pulmonary edema (ACPE), can reduce the need for intubation, resolve symptoms faster, and reduce the hospital/ICU length of stay and mortality significantly. Only 13 patients with ACPE need to be treated in order to save one extra life, and 9 patients to avoid an extra intubation.

New Study: Facemasks and Hand Washing Can Decrease Flu Transmission at Home

by Wm. Ken Milne MD, MSc on December 14, 2009

2009 Influenza Update // Best Evidence in Emergency Medicine

Do Facemasks Work at Home? New study shows facemasks and hand washing decrease flu transmission at home if caught early.

Pre-Hospital Cardiac Arrest: When to Pull the Plug

by Jonathan Sherbino, MD on October 14, 2009

The Setup:

A young woman finds her 59-year-old father in his bedroom, absent of vital signs. Upon EMS arrival, CPR is initiated. In the midst of your busy evening shift, you receive a radio patch from EMS personnel.

Diagnosing Pediatric Urinary Tract Infections

by Rupinder Sahsi, BSc, MD on September 8, 2009

Although diagnosing urinary tract infection (UTI) in a pediatric population can be challenging, pre-test probability can be guided by specific risk factors in the history and physical examination. Among low-risk children, further laboratory testing can be deferred in favor of a conservative approach.

The Setup

You've spent your morning locked in administrative meetings. After being serenaded at length by the budgetary mantra to cut costs while maintaining high-quality patient care, the chaos of your subsequent afternoon ED shift is almost a welcome contrast. The next chart in the rack, though, brings back memories of the morning's subject matter...

The Evidence Behind the 4.5-Hour t-PA Window

by Christopher Carpenter, MD, MSc on August 3, 2009

Extending the window for t-PA (alteplase) thrombolysis in acute ischemic stroke within 4.5 hours of symptom onset is not associated with an increased risk of symptomatic intracranial hemorrhage or death and does improve good outcomes at 90-days.

The Case
A 75-year-old female with a history of hypertension and a left-sided stroke 10-years ago presents 2.5 hours after the onset of left arm and leg weakness while playing bridge. After obtaining her head CT, labs, and history you note no contraindications to thrombolytic therapy (Table). Unfortunately, 3.5 hours have now passed since her symptoms began. Her husband, a retired Pediatrician, astutely notes recent professional organizations and newswire reports advocating thrombolysis for acute ischemic stroke at up to 4.5 hours.

Pro/Con Should tPA be Administered at 4.5 hours?

by Kevin Klauer, DO & Chris Carpenter, MD on August 3, 2009

Opening argument: NO