Journal Club - Racism is a Public Health Problem

Journal Club - Racism is a Public Health Problem

In the United States, racism is a critical public health problem, permeating everyday systems including educational and health care systems; criminal justice and legal systems; financial, housing, and economic systems; environmental issues and beyond to create differential health outcomes that adversely affect Black, Indigenous, and other people of color. This pervasive system of power is based on the socio-politically constructed notion that non-Hispanic white people are inherently superior to people of color (Black, African American, Indigenous, Native American, Alaska Native, Native Hawaiian, Pacific Islander, Asian, Latine, Hispanic) and this ideology operates across multiple levels (individual, interpersonal, institutional) to unjustly advantage non-Hispanic white people, unjustly disadvantaging people of color. We recognize that racism is an important cause of health disparities and that, as health care providers, we have a responsibility to educate ourselves about racism so that we will be prepared to acknowledge the impact of racism on our patients’ health and work towards more equitable systems in support of health equity. One important component of that education is learning how to engage in productive conversations about race and racism. In service of that goal, we chose Ijeoma Oluo’s book, So you want to talk about race, as our common read for this special Journal Club session.

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Journal Club - Optimal Pharmacology for Alcohol Withdrawal

Journal Club - Optimal Pharmacology for Alcohol Withdrawal

Alcohol abuse is common in the United States with 14.1 million adults estimated to have some degree of alcohol use disorder. Emergency physicians will encounter this quite often, either as the primary presenting problem or as a complicating factor in a patient’s care. Unfortunately, alcohol consumption appears to be increasing, with the World Health Organization projecting ongoing increases through at least 2025. As a result, it is becoming increasingly important that we understand the serious and potentially life-threatening consequences of alcohol withdrawal syndrome (AWS) and the treatment options that exist in order to best manage these patients. The following three journal club articles sought to investigate potential clinical benefits for the use of phenobarbital in the emergency department (ED) for the treatment of AWS.

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Journal Club - Emergency Department Initiated Buprenorphine for Opioid Use Disorder

Journal Club - Emergency Department Initiated Buprenorphine for Opioid Use Disorder

Recent data from the National Center for Health Statistics reveal that in the 12-month period ending in April 2021, more than 100,000 Americans died of an overdose, a staggering increase of nearly 30% the prior year. While the ongoing COVID-19 pandemic has contributed to overdose deaths and taxed constrained ED resources, it has also clarified the important role that emergency physicians have in expanding access to life-saving medications to treat opioid use disorder. In this journal club, we review the evidence on ED-initiated buprenorphine, including barriers to implementing ED-buprenorphine here in rural Maine.

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Journal Club - Physician Depression and Suicide

Journal Club - Physician Depression and Suicide

Suicide is disturbingly prevalent among patients we care for in the Emergency Department. It is unfortunately also common among physicians. Most estimates suggest that approximately 400 physicians die by suicide annually. Physicians also have a higher rate of suicide than the general population. Male physicians have a 40% increased risk of suicide compared to their age-matched peers and female physicians have a 130% increased risk. We chose this topic for Journal Club with the goals to raise awareness around these shocking statistics, discuss etiologies behind these high rates of suicide and to normalize the discussion around physician mental health.

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Journal Club - Pain management of Renal Colic

Journal Club - Pain management of Renal Colic


Renal colic is a commonly encountered diagnosis in the emergency department that is known to cause significant pain. In clinical practice, the initial goal is prompt pain management while simultaneously working to confirm the suspected diagnosis. Because of the severity and acuity of the pain associated with renal colic, opioid pain management has often been used. Given the overall goal of reducing the use of opioid pain medications, emergency physicians have been working to identify alternative pain management strategies with agents such ketorolac and lidocaine. In this journal club, we examine the evidence in support of these treatment strategies.

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Journal Club - Gender Bias and Discrimination in emergency medicine training

Journal Club - Gender Bias and Discrimination in emergency medicine training

On January 23rd, 1849 Elizabeth Blackwell became the first female graduate of a US medical school, graduating from Geneva College in New York as the Valedictorian of her class. Despite the passage of 172 years from that remarkable moment, female physicians continue to face both implicit and explicit gender bias within the medical profession and culture. This journal club examined the impact of gender bias on female emergency medicine trainees.

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Journal Club - Tranexamic Acid in Trauma

Journal Club - Tranexamic Acid in Trauma

The use of TXA in the care of the trauma patient has become prevalent since the publication of the MATTERs and CRASH-2 studies which demonstrated significant mortality benefits in trauma patients who received early TXA after admission. Since these publications, there continues to be several additional questions regarding its TXA: 1) If earlier treatment with TXA for the trauma patient is better, would there be benefit in its administration in the prehospital setting? 2) Is there benefit to the use of TXA in patients with TBI to prevent the progression and subsequent morbidity and mortality? 3) Lastly, does TXA carry a significant risk for side effects, including venous thromboembolic events? This journal club reviewed four articles that aim to answer these questions.

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Journal Club - COVID-19 Therapeutics

Journal Club - COVID-19 Therapeutics

COVID vaccines have dominated the media and our recent efforts to combat the SARS-CoV-2 virus. It will likely take some time, however, until we reach herd immunity. To help curb the severity of disease, the medical community continues to investigate other therapeutics. By examining the virus life cycle and our immune system’s response to it (both protective and destructive), we may be able to develop anti-viral and immune therapy that counteracts the cytokine storm and leads to acute respiratory distress syndrome, respiratory failure, shock, organ failure and potentially death. In this journal club, we reviewed the use of steroids and convalescent plasma for the treatment of patients with SARS-CoV-2.

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Journal Club - Vasopressor use in Cardiac Arrest

Journal Club - Vasopressor use in Cardiac Arrest

Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar with the properties of, and indications for, vasopressors in the ED setting. In this journal club summary, we review the evidence on the impact vasopressors have on clinical outcomes.

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Journal Club - Concussion Management…Brain Rest or Light exercise?

Journal Club - Concussion Management…Brain Rest or Light exercise?

Despite the widespread prevalence of concussions, little is known about its ideal management. The traditional recommendation for concussion treatment has centered around the concept of “brain rest” in addition to physical rest. There is little medical evidence to support this recommendation. Our journal club sought to answer whether some physical activity could actually benefit patients with acute concussion and additionally reviewed a study (completed in Maine) that challenged the belief concussions have long term cognitive effects. Read on to see what you think!

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