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EMDutch Review – Jan 2014

3 Feb

This month a short EMDutch Review. Currently I am doing the MNSHA Masterclass about “Acute Medical Emergencies” until April 2014. It takes a lot of time and since there are only 24h in a day there is less time for EMDutch.

Here we go!



In this study, these authors attempt to reduce testing for pulmonary embolism by creating a shared decision-making framework to discuss the necessity of testing with patients. After viewing the benefits and risks of CTPA, 36% of patients in this study stated they would hypothetically decline testing for PE.The authors conclude, based on a base case of 2.6 million possible PE evaluations annually, this strategy might save 100,000 CTPAs a year in the US. I think the approach these authors promote is generally on the right track.  The challenge, however, is the data used to discuss risks with patients.


EMDutch Review – Happy New Year

4 Jan

Let’s start with wishing you all the best for 2014! We hope 2014 is going to be even better than 2013, which was already a great year for us! 2013 was the 1st full year of EMDutch and we hope we can improve the site in the following years.

And now the 1st EMDutch Review of 2014!


EMCrit: The Targeted Temperature Trial Changes Everything

An article in the december 2013 issue of the NEJM compared normothermia vs hypothermia for unconscious survivers of out-of-hospital arrest. Their conclusion: In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C.

It is probably enough to prevent fever!

EMLitofNote: The Latest Myth: Contrast-Induced Nephropathy?

Here’s the simple explanation for why none of our observed treatments to prevent contrast-induced nephropathy – acetylcysteine, hydration, sodium bicarbonate – reliably work:  CIN is a myth.


EMDutch Review – Oct/Nov ’13

1 Dec

After the “Halloween” Review we now have a normal EMDutch Review from the months October and November. If you feel you don’t have time to look at everything I would advice you to take a look at the presentation from H. Gilbert Welch about over diagnosing. A must see for all doctors out there!!! Share this with your colleagues!


LITFL: Hyponatraemia

Hyponataemia in a nutshell

Presentations and Videos

ALiEM: Patwari academy videos: Evidence based Medicine – part 1

Who doesn’t love epidemiology ☺? Well……If you do are here some great videos about sensitivity, specificity and all the other things you just love! It’s not as hard at it seems! Just take a look at this picture. Here you see some of my own residents doing epidemiology…..You can see they just love it ☺ !

foto assistenten

#EMDutch Review – The Halloween Edition

31 Oct


Be advised: This month’s “special” review is written in blood (which was a silly thing to do, it took me ages to clean the keyboard afterwards)

A little known fact about vampires is that longevity means there will come a point when you need dentures. Luckily blood can be thinner than water : 25% of trauma patients suffer from acute coagulopathy of trauma from the moment they enter your ED. This is caused by shock itself (due to activation of anticoagulant and fibrinolytic pathways) and not the classically taught combination of acidosis, hypothermia, dilution and consumption. If you didn’t know this, go listen to: coagulopathy and if you did know, then go listen to it anyway. There even is an European guideline, which you really should go and read.

But how do we know which of our patients suffer from coagulopathy ? It may be present even with an INR of 1.2, so maybe we need another test or maybe you need to listen to this: TEG. Alternatively you could read this: thromboelastogram, you probably should (read it).

Now if you’re one of these thin blooded people then you probably want to know how to protect yourself from edentulous vampires. Should you use garlic or transexamic acid ? The answer can be found here: how CRASH-2 got it wrong. You should listen to it.

Quick, look behind you! Ah no, the evil bloodsucker got you. Now what ? Should you transfuse yourself ? Not according to this: GI bleeds. Guess you should read it. Maybe you should use haemostatic resuscitation ? (hint: listen to it) And is there a real benefit from 1:1 transfusion or is it solely due to survival bias ? Read it. Read it all !!

See you later

Iwan Dierckx

Now I probably should go and see a dentist, I have this painful canine tooth…

#EMDutch Review- 5

3 Oct

Welcome to the #EMDutch Review from October 2013. From now it will be bimonthly! We have a great podcast by Dr. Weingard about tubing the shocked patient. Furthermore we have great tips for you FOAM beginners out there, a video on lateral canthotomy and much more!


iTeachEM: Great tips for FOAM beginners

Great tips by Chris Nickson for FOAM beginners. Be active, be nice, be a tweeter and much more!

EMS World Expo: STEMI Mimics

Not every ST-elevation is an STEMI! Just think about pericarditis, brugada, ventricular aneurysm etc. Here is a great overview! (in pdf)