Must Own Articles File... Please Contribute

[chitownxfer]

I would like to create a community list of important "gold standard" journal articles related to EM (unless this wheel has already been invented). Ideally we could read them all and keep a copy in an email folder to readily share with each other or medical students.
Articles that come to my mind include:


Decision Rules
-Canadian & New Orleans &Nexus II Head CT
-Nexus c-spine
-Ottawa ankle, foot, & knee
-Pittsburgh knee
-Centor strep throat
-San Francisco syncope
-?other rules

ACLS
PALS
Rivers sepsis
Opiates & evaluation of acute abdomen, Ranji
EP recognition of adverse drug events, Hohl
Domestic violence, Director
STD managment recommendations, CDC
?best UA/NSTEMI, STEMI article

I am interested to learn which articles each of you would recommend be placed on this list.

Thanks,
Chitownxfer

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[Dr. Will]

This type of thread has already been started...

http://forums.studentdoctor.net/showthread.php?t=368422

 

[chitownxfer]

Thanks for introducing me to the wheel Dr. Will

I think that the "so there file" should be placed under EM journal club and this type of discussion continued. I would recommend expanding the nature to be more inclusive of all high-yield EM articles, rather than limit the scope to those that will tell off "pesky consultants."

I am surprised that no one has compiled a website with systems based folders with these type of key EM articles (I know about the ABEM LLSA-which is the best I have found). Does anyone out there have the articles and resources to create such a webpage?

CTXF

 

[Dr. Will]

Thanks for introducing me to the wheel Dr. Will

I think that the "so there file" should be placed under EM journal club and this type of discussion continued. I would recommend expanding the nature to be more inclusive of all high-yield EM articles, rather than limit the scope to those that will tell off "pesky consultants."

I am surprised that no one has compiled a website with systems based folders with these type of key EM articles (I know about the ABEM LLSA-which is the best I have found). Does anyone out there have the articles and resources to create such a webpage?

CTXF

I agree...it should contain both types. I'm hoping the previous thread would be "stickied" for easy search and access.

 

[USCDiver]

Whatever you do, don't put it in Journal Club! that place is a barren wasteland.

 

[FoughtFyr]

I agree...it should contain both types. I'm hoping the previous thread would be "stickied" for easy search and access.

There is a list of "former stickies" that is stickied. The "so there" thread is on that list...

- H

 

[EctopicFetus]

we just covered the rivers sepsis article in our journal club. one of our faculty members is one of the authors... pretty cool.

 

[Dr. Will]

There is a list of "former stickies" that is stickied. The "so there" thread is on that list...

- H

My bad...didn't realize it was there.

 

[tkim]

My bad...didn't realize it was there.

Ditto.

 

[USCDiver]

This type of thread has already been started...

I think the focus of this thread should be different from the 'so-there' thread.

That thread is more about articles to pull out when you need ammo against a recalcitrant consultant or attending.

This thread should be more about 'standard of care' articles for EM.

my $0.02

 

[Jeff698]

I am surprised that no one has compiled a website with systems based folders with these type of key EM articles (I know about the ABEM LLSA-which is the best I have found).

If you'd like to see the site I put together, drop me a PM and I'll send you the URL. I'd just as soon not post it here since it's my personal server but I don't mind sharing with y'all in private.

Take care,
Jeff

BTW, I've included both kinds of articles. It morphed quickly into a place for useful articles of any flavor.

 

[Radiohead]

How about the PE rule out criteria (PERC rule) and the Charlotte Rule for deciding who can be safely be ruled out w/ a neg D-Dimer.

As for the SF syncope rule, we just had a journal club on it and the consensus amongst our attendings was that it was not ready for clinical use yet as it has only been "validated" in 1 center w/ 500 or so pts. Most of the clinical rules you listed like NEXUS and Candadian csp rules have been tested on tens of thousands of patients. Also notice that the SF rule does not include age, so you could theoretically "safely" d/c a 90 y/o who passes out w/ chest pain and palpitations (but no SOB). C'mon you gotta be kidding me.

 

[chitownxfer]

Great additions Radiohead, I appreciate your thoughts on syncope. Although I haven't seen too many 90 year olds with stone cold normal EKG's (just playin, you make a great point).

In this month's Annals, Ben Sun has an nice validation study applying the SFSR to 477 pt's. His findings support your concerns. He found the SFSR to be only 89% sensitive (versus the 96-98% reported in other studies). The majority of serious "misses" were in pt's > 60 years old.
As you said, additional studies need to be conducted. I believe the SFSR study is still worth utilizing in clinical practice along with a couple of additions from other studies (some evidence is better than voodoo or admitting everyone). (Also check out ACEPs clinical policy statement on syncope in the same issue)

My practice is to utilize a modified SFSR + common sense. The important additions IMO are age >60, structural HD & CAD.

BTW a useful acronym for a modified SFSR (CHESSS)
C-Cardiac disease (CHF, CAD, SHD)
H-Hct <30
E-EKG (abnormal)
S-SOB
S-SBP <90
S-Sixty (>60 yo)

Syncope in young pt's (<35) is a sticky situation indeed, without good evidence to guide us. This is where h&p are paramount: look at hx-absence of prodromal sx, preceding events, evaluate for HOCM, long QT, FH of sudden cardiac death, Brugada. Look for alternate diagnosis. (e.g.+dizziness with orthostatic exam).

I think in the gray zone cases the key is to inform our patients of the risks/benefits/options and allow them input on how to proceed. Then document like hell.

Salud,
Chi