WPW tachys demystified

Dr Amal Mattu clarifies, and I do mean makes crystal clear, the different types of WPW syndromes.
Especially the part where he states that too much is said about these things!




For more of his videos, go to his UMEM website.

Is this the end of therapeutic hypothermia?

Hot off the press from NEJM.org, comes a study from the Scandinavian lands. There, a rigorous well conducted study involving almost a thousand post-cardiac arrest patients were randomized to two temperature management groups; 33 versus 36 degree Celsius.
What do you know, there is NO difference in mortality between the 2 groups (primary outcome), or neurologic function (secondary outcomes).
Is this history repeating itself? The medical literature contains numerous examples of study interventions where initial small(er) studies claim benefit, get trumpeted by the medical community, and later large randomized trials debunk the initial findings. Therapeutic hypothermia may be one such example. In fact, critics of hypothermia often cite the small sample sizes of the initial landmark studies as a reason for potential biases.
Does this then spell the end for induced therapeutic hypothermia after cardiac arrest? This is difficult to answer, and may even raise more questions with this latest trial. It's been more than ten years since the first landmark trials were published in 2002, and a lot have changed since then. Care of the post-arrest patients is bound to have improved with time and recognition of the post-arrest syndrome.
But this study does highlight a few points:
  • Hyperthermia after ROSC is probably bad. The early trials did not control for the temperature of the control groups and that may account for the difference in outcomes.
  • In this study, every patient got CPR very quickly and the median pulseless intervals were less than 30 minutes in both groups (you'd expect that in a Scandinavian country). Therefore, the majority were VF collapses, and the patients got ACLS in 10 minutes. We do know that people tend to do better the less time they spend in arrest so this in itself may contribute to better outcomes in any group regardless.
  • The study was praised for standardising an algorithm to withdrawal of life-sustaining care - a first, and very well thought out.
  • Targeted temperature PROBABLY works, just keep to under 37 degrees. We still do not know which is best.
Read the article and the accompanying editorial below; what do you think?

Webucation 18/11/13

We took a break for some family vacations but are back with more web trails for you. Meducation continues with snippets from paeds, cardio, trauma and good old "robots replacing us" prophecies!
  • Stop shouting! - This last article is a great illustration that EDs, institutional practices and medical staff interaction are the same around the world. There's always comfort in the chaos if you keep the channels of communications open though. 

SEMS Annual Scientific Meeting 2014 registration now live!

The Society of Emergency Medicine in Singapore is pleased to present their ASM 2014.

Registration with pre-conference workshops and early bird rates are all now live at the following link:

www.sems2014.com

See you in April!

More ECGs in de Winter

Dr Amal Mattu gives us more examples of the relatively new STEMI equivalents that you should look for in your acute chest pain ECGs. Watch out for those upsloping ST segments in a clinically relevant case.



For more of his videos, go to his UMEM website.

SEMS ASM 2014 abstracts call


This is the premier ED conference in Singapore and abstracts are open. (Yes, we are biased)
Spread the word and sign up!




Picture Power

RR, RRR, ARR, NNT, chance, percentages …… these are common ways of presenting results of studies about therapy or harm. 

I have always struggled with how best to re-articulate the above numbers to an intended audience (patients, residents, colleagues … and sometimes myself) such that the magnitude of results can be appropriately conveyed and understood. 

During one of those nights trawling online for EBM-teaching resources, I stumbled upon a website with an animation function called "Spinning the Risk". Looks like a potential goldmine! 

I decided to try it out after coming across the post "Colchicine for Pericarditis: Do It" by Ryan Radecki, based on a study by Imazio et al

The goal of the study was to evaluate the efficacy and safety of colchicine, in addition to standard therapy, for treating a first attack of acute pericarditis. The primary outcome was "incessant or recurrent pericarditis" (efficacy) and one of the main adverse effects was "gastrointestinal disturbance" (harm).

In other words, if I am a patient with my first attack of acute pericarditis, tell me:
1. What are my chances of experiencing incessant or recurrent pericarditis with and without colchicine?
2. What are my chances of experiencing gastrointestinal disturbances with and without colchicine?

Instead of quoting the respective percentages from the study, how about showing me this:


Picture Power!