November 6, 2020

October Journal Club

By ejschwartz

Dr. Ashley Jacobson is an emergency medicine resident physician in Rochester, MN.

Dr. Alexis Del Vecchio is an emergency medicine resident physician in Rochester, MN.

Dr. Sara Hevesi is an emergency medicine consultant physician in Rochester, MN.

Dr. Neha Raukar is an emergency medicine consultant physician in Rochester, MN.

Dr. Tobi Kummer is an emergency medicine consultant physician in Rochester, MN.

The fourth Mayo EM residency journal club was a joint effort with Regions Hospital EM residency on October 22, hosted by consultant physician, Dr. Tobi Kummer. Regions calls their journal club Regions RAP (reviews and perspectives), and hence the combined conference was dubbed “Minnesota RAP”.

Articles reviewed were Cannabinoid hyperemesis treatment, Eye glue mishap, the Recovery Trial, Does NPO mean an empty stomach?, and Microaggressions. You can find Regions’ post about the combined journal club on their website, https://regionsrap.com/ .

Dr. Broc Schindler (Regions resident) presented on the EM Pharm MD post on cannabinoid hyperemesis syndrome (CHS) and treatment. This article was a good overview of CHS and its pathophysiology. It was a good reminder to keep this on the differential since clinical diagnosis can minimize unnecessary testing and treatment. This article suggested that capsaicin can be used as a first line treatment with consideration of anti-emetics (Haldol) and fluids as needed.

Dr. Ashley Jacobson presented on a review and exploratory trial article on removal methods of Histoacryl, a medical-grade tissue adhesive, written by Liu in 20201. This was posted on JournalFeed, a partnership with Hippo EM. This novel study assessed what happens when you inadvertently glue the eyelid and how to remove it. Twenty-four different compounds were tested across three testers on a porcine model to mirror live human eyelid tissue. This article found neomycin-polymyxin B-dexamethasone (Maxitrol) antibiotic drops can complete removal by 2 hours, which was the clear winner from the other compounds. This study, while small, does have the possibility to change practice for some emergency providers since there is no current standard of care for tissue adhesive removal.

Dr. McKinzy Butler (Regions resident) presented on the First10EM post on the Recovery Trial (the preprint version of the paper by Horby2). This multicenter RCT from the United Kingdom reviewed the utility of decadron in patients with COVID 19, an incredibly important and pertinent study given the current pandemic. The study did show a reduction in 28-day mortality with 6mg of decadron given daily. The best evidence was in those who were on supplemental oxygen and there was suggestion that decadron is helpful later in the course of disease, rather than early on in the viral replication phase. The paper is not yet peer reviewed, but given the pandemic many studies are being published and pushed through earlier than they would normally.

Dr. Alexis del Vecchio presented on the Moake article which was also found on JournalFeed. This prospective observational study found that despite meeting fasting ASA guidelines, most pediatric patients undergoing procedural sedation and analgesia in their urban academic pediatric ED did not have an empty stomach. In fact, 80% of patients undergoing PSA in the department had gastric content classified as “high risk” (solid/thick liquid content) despite a median fasting time of over 6 hours. No patients had aspiration events. This lends credence to ACEP’s clinical policy not to “delay procedural sedation in adults or pediatrics in the ED based on fasting time.” Their study population is applicable to our own at Mayo, suggesting we should not delay PSA in our pediatric ED if medically necessary for procedures.

Dr. Raukar summarized the Annals of Emergency Medicine article on Microaggressions in medicine. The practice of medicine includes more than what is read in a textbook. Emergency medicine, being especially team based, requires that all members of the team understand each other's roles and value each other's opinions. The quality of healthcare delivered is dependent on a good working relationship between physicians and nurses, despite gender similarities or racial differences. This article went through numerous studies where there is evidence of microaggressions from female nurses to female physicians when compared to male physicians and between racial groups. This was a nice review of the different forms of microaggression encountered in nearly every possible interaction between physicians and nurses. Although not a clinical study, this article does explore microaggression, "subtle, stunning, often automatic, and non-verbal exchanges which are ‘put downs’ of blacks, women or other minorities. Understanding this topic, recognizing the behaviors, and then addressing them is critical to the delivery of optimal patient care. Follow Neha on Twitter for more @NehaRaukarMD!

For this brunch journal club we feasted on some delicious food from Benedict’s Restaurant in Rochester. Dr. Kummer’s dog Oliver was again in attendance and paying very close attention to the presented articles and discussion! The next journal club will be November 17th at 6pm, hosted by Program Director Jim Homme. We will be discussing trigger point injections. We hope to see you there!

Our in-person group
The WebEx virtual discussion between the Regions and Mayo crews
Oliver (Dr. Kummer is his human) having a thoughtful look at this month’s articles with Dr. Jacobson

1. Liu, Z, Lim, YT, Fai, K, Leong, M. Inadvertent tissue adhesive tarsorrhaphy of the eyelid: a review and exploratory trial of removal methods of Histoacryl. Emerg Med J. 2020; 37: 212-216

2. Horby PW et al. Effect of Dexamethasone in Hospitalized Patients With COVID-19 – Preliminary Report. medRxiv Preprint 2020

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