Welcome to another EBM packed nerdorama with my mate Dr Justin Morgenstern outta Canada. This episodewe talk about kangaroo trauma, Bell’s palsy, HEAR(T) scores, Covid, Adrenaline (again), PPIs (Again) and how sex can improve your nasal function. Yep, all the usual stuff! The audio is at the bottom or listen on iTues or in your favourite app. Please take a moment to rate us on iTunes to help us feel validated !

Bell’s Palsy and Leukemia in Children Babl FE, Kochar A, Osborn M, Borland ML, West A, Williams A, Dalziel SR; PREDICT network. Risk of Leukemia in Children With Peripheral Facial Palsy. Ann Emerg Med. 2020 Aug 9:S0196-0644(20)30491-1. doi: 10.1016/j.annemergmed.2020.06.029. PMID: 32788067

Avoiding troponin (and the problems with modern medicine) Smith LM, Ashburn NP, Snavely AC, Stopyra JP, Lenoir KM, Wells BJ, Hiestand BC, Herrington DM, Miller CD, Mahler SA. Identification of very low-risk acute chest pain patients without troponin testing. Emerg Med J. 2020 Nov;37(11):690-695. doi: 10.1136/emermed-2020-209698. Epub 2020 Aug 4. PMID: 32753395

Humans need food and drink. Despite rumors, physicians are humans. Food and Drink for Staff in the Emergency Department. Ann Emerg Med. 2020 Oct;76(4):e75. doi: 10.1016/j.annemergmed.2020.06.014. PMID: 33012396

Delayed reactions to COVID vaccinations Blumenthal KG, Freeman EE, Saff RR, et al. Delayed Large Local Reactions to mRNA-1273 Vaccine against SARS-CoV-2. N Engl J Med. 2021; [article]

COVID is airborne Greenhalgh T, Jimenez JL, Prather KA, Tufekci Z, Fisman D, Schooley R. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. The Lancet. 2021; [full text article]

1. Superspreading events have been incredibly common, and are clearly best explained by airborne transmission
2. There are multiple documented cases of long range transmission
3. Asymptomatic spread – ie from people not producing significant droplets – is incredibly common
4. Indoor transmission is higher than outdoor – that only makes sense with airborne spread
5. Nosocomial infections are occurring even with strict adherence to droplet contact PPE
6. Viable SARS-CoV-2 has been detected in the air
7. SARS-CoV-2 has been found in air filters and air ducts
8. Animal studies, where animals are separated in a way that only aerosols can spread between cages, show airborne spread
9. There is really no evidence against airborne spread
10. There is really no direct evidence that COVID is droplet spread

Bottom line: COVID is an airborne disease, and our policies and PPE decisions should reflect that fact.

Once again: Routine testing should not be performed before psychiatric admissions Farkas A, Lipanot K, Sherman K. Routine Laboratory Screening for Acetaminophen and Salicylate Ingestion in Preadmission Psychiatric Patients Is Unnecessary. Annals of Emergency Medicine. 2021;

Epinephrine in cardiac arrest: still no good evidence of benefit Haywood KL, Ji C, Quinn T, Nolan JP, Deakin CD, Scomparin C, Lall R, Gates S, Long J, Regan S, Fothergill RT, Pocock H, Rees N, O’Shea L, Perkins GD. Long term outcomes of participants in the PARAMEDIC2 randomised trial of adrenaline in out-of-hospital cardiac arrest. Resuscitation. 2021 Mar;160:84-93. doi: 10.1016/j.resuscitation.2021.01.019 PMID: 33524488

Another “we already knew that”: PPIs are useless for upper GI bleeds Serpico M, Riscinti M. Proton Pump Inhibitors for Acute Upper Gastrointestinal Bleeding. Acad Emerg Med. 2020 Apr;27(4):336-338. doi: 10.1111/acem.13899. Epub 2019 Dec 29. PMID: 31808973

The theme of the month is things we already knew. This time: CT contrast does not cause kidney injury. Goulden R, Rowe BH, Abrahamowicz M, Strumpf E, Tamblyn R. Association of Intravenous Radiocontrast With Kidney Function: A Regression Discontinuity Analysis. JAMA Intern Med. 2021 Apr 5. doi: 10.1001/jamainternmed.2021.0916 PMID: 33818606

Bushfires and kangaroo injuries Hardy P, Harris D, Clarke C, Ellis DY. Increased incidence of kangaroo-related trauma following a severe bushfire season. Emerg Med Australas. 2021 Mar 4. doi: 10.1111/1742-6723.13761. PMID: 33665990

ROADKILL RECIPES by Tim and Trish Leeuwenberg if you want to cook and eat your vehicular victims

Need an excuse for sex? It will help you breathe Bulut OC, Oladokun D, Lippert BM, Hohenberger R. Can Sex Improve Nasal Function? An Exploration of the Link Between Sex and Nasal Function. Ear Nose Throat J. 2021 Jan 4:145561320981441. doi: 10.1177/0145561320981441 PMID: 33393816

Bottom line: Sex is good. Depending on your life circumstances, sex might be cheaper than a nasal decongestant. (Then again, it might not be.)