Tales are often told of an exhausted travel who has lost their way in the desert, and are drawn astray by the the sight of a lush oasis. But as they draw close, their salvation vanishes only to reappear on the distant horizon. This optical tormentor continues to lead the hapless travelers further and further […]
EM Nerd-The Case of the Cryptic Truth
On the morning of January 1st, 2017 a number of proud South Carolinians woke up to find themselves no longer living in their former state of residence. Without moving from the beds in which they slept, they were all magically transported into the neighboring the state of North Carolina. Due to a border dispute which […]
EM Nerd-The Case of the Otalgic Squire
As the year draws to a close it is safe to say that it has not been a productive twelve months for antibiotic stewardship in the Emergency Department. A recent example is the latest NEJM publication by Hoberman et al examining the efficacy of antibiotics for children with acute otitis media (OM) (1). Using a […]
CC Nerd-The Case of the Uncertain Surrogate
I’ve often wondered if the devastating outcomes observed in patients presenting in status epilepticus (SE), are far more influenced by the underlying etiology inciting this seizure activity than the time it takes us to control this neurological outburst. And while the HYBERNATUS study does not directly address this question, it does allow for some interesting […]
EM Nerd-An Addendum to the Case of the Incidental Bystander Part II
Recently I wrote a post discussing overdiagnosis in the workup for pulmonary embolism (PE). In it we discussed a recently published paper, the RESPECT-ED trial. Shortly after posting I was contacted by the lead author, Dr. David Mountain, with a number of comments and concerns on how the trial was represented. I have included it […]
EM Nerd-The Case of the Incidental Bystander Part II
The existence of overdiagnosis in the pursuit of pulmonary embolism (PE) is undeniable. But the burden of clinically insignificant PEs diagnosed by our current hypersensitive, zero-miss culture is less apparent. The authors of a recent article ironically entitled RESPECT-ED, attempted to quantify the role in which overdiagnosis plays in the current incidence of PE. Recently […]
CC Nerd-The Case of the Sussex Vampire Continues…
Catheters designed for superficial vessels that can be identified by palpation or direct visualization are not effective in accessing the deeper veins of the upper extremity. We have discussed the follies of ultrasound (US) guided peripheral venous catheters in a previous post, but in brief their length and intent hinder their reliability, so much so […]
EM Nerd-The Case of the Incidental Bystander
It is quite uncommon that while reading the results of a clinical trial one feels the universal gasp of sorrow released from the hearts and minds of Emergency Physicians worldwide. Maybe it was my own personal anguish at the realization of the disastrous consequences the results of a recent trial published in the NEJM will […]
EM Nerd-The Case of the Tell-Tale Heart
We can all agree that the use of bedside ultrasound (US) has changed the practice of Emergency Medicine for the better. But with the addition of such a tool, we are now faced with the question of how best to apply this novel modality into our practice. The emergency management of cardiac arrest seems like […]
EM Nerd-A Case of Confounding Factors
So much of our critique of the medical literature is focused on the quantification of random error. Attempting to differentiate a true divergence of sample populations from random chance. Typically, we assess this probability via the p-value. This number represents the likelihood that the results observed, or a more extreme version, would occur if no […]
CC Nerd: The Case of the Decompressed Cranium
In 2011 Cooper et al published the DECRA trial examining the use of decompressive craniectomy in patients with traumatic brain injuries (TBI) and elevated intracranial hypertension refractory to medical management (1). Shockingly what was until then thought of as a lifesaving procedure was found to be inferior to conservative medical management. Many have discredited the […]
EM Nerd-The Case of the Erratic Pendulum
In January 2015, the NEJM published the results of the MR CLEAN trial. Its findings sent ripples through the world of medicine (1), as the first RCT to demonstrate a benefit for endovascular therapy in acute ischemic stroke. In its wake 6 trials were left marooned, their enrollment halted prematurely due to the benefits demonstrated […]
CC Nerd-The Case of the Unmeasured Factors
For some time now thromboelastography (TEG) and related viscoelastic tests have been the darlings of the FOAM world. I must admit, even I have been seduced by their elegant and holistic perspective of the coagulation system. And yet despite their clinical potential and widespread patronage, few studies have examined how the use of TEG to […]
EM Nerd-A Case of Central Tendencies
The REACT-2 trial is an RCT comparing two different diagnostic strategies in a cohort of patients presenting to the Emergency Department with severe trauma (1). And while the authors found no difference in clinical outcomes between patients randomized to total-body vs selective imaging strategies, they did report a statistically significant difference in the total dose of […]
EMNerd-The Case of the Dysrhythmic Heart
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