Our obsession with diagnostic certainty has led us down many false paths and blind alleyways in the history of medicine. This statement has never been more true than when spoken in regards to cardiovascular health. The small successes that we have obtained when treating the highest acuity patients have been enthusiastically and incorrectly applied across […]
EMDOCS.net hosted me on Ask Me Anything
EMDOCS.net brought me on for an AMA session
10 Pearls from the Levitan Airway Course
0 Introduction 0 Last week I attended Dr. Levitan’s airway course in Baltimore. It was a teriffic course, which I would recommend to anyone looking to improve their airway management skills. For those of you unable to attend the course, here are some points which were particularly interesting to me. 0 Pearl #10. Respect the […]
EMCrit Wee – I Thought This Would be the One, but Nope….
Smells like some confirmation bias here
Early norepinephrine to stabilize MAP in septic shock
0 Introduction 0 With publication of the PROCESS and ARISE trials, many hemodynamic goals are being disproven. There is a growing tide of nihilism. Should we should just give septic patients a couple bags of fluid, some antibiotics, and hope for the best? 0 Probably not. PROCESS and ARISE have showed us what we can […]
EMCrit 134 – ARISE has arisen; now where do we stand on Severe Sepsis in 2014
the Arise Study (Australasian Resuscitation In Sepsis Evaluation) and Severe Sepsis Care in 2014
Which Pacemaker/ICD is that Again
figure out which device from the xray
Myth-busting: Lactated Ringers is safe in hyperkalemia, and is superior to NS.
Introduction 0 Several months ago I gave a grand rounds on pH-guided resuscitation which was summarized in this post. This included a discussion that Lactated Ringers (LR) is safe in hyperkalemia. However, myth-busting is hard work. The dogma that LR should be avoided in hyperkalemia continues to replicate, both locally and on twitter. This […]
EMCrit 133 – The First Prehospital REBOA
London HEMS docs peform REBOA and save a life
Large volume thoracentesis: How much can safely be removed?
0 Introduction 0 Completely draining a pleural effusion has many benefits including symptomatic improvement, avoiding multiple procedures, faster disposition home, and imaging the chest with the lung inflated. However, complete drainage is usually avoided to due to fear of re-expansion pulmonary edema. What is the evidence behind this? 0 Traditional model of reexpansion pulmonary edema (RPE) 0 […]
EMCrit Wee – Aggressiveness and the New Cutdown with Leon Boudourakis, MD
Need access–this may be a way
Pneumothorax ex vacuo: Post-thoracentesis pneumothorax in the ultrasound era
CT showing pneumothorax ex vacuo due to trapped lung (Pereyra 2013) 0 Introduction 0 A recent review article by Wilcox in JAMA questions whether ultrasound guidance truly reduces the risk of pneumothorax. Bedside ultrasound reduced pneumothorax (OR = 0.55) but this reduction was statistically insignificant due to a huge confidence interval of 0.06-5.3. Another meta-analysis found […]
“The Adventure of the Sussex Vampire”
A brief forethought. This post we will stray from the usual whimsical rants regarding recent literature in Emergency Medicine. Instead we will focus on the far more practical topic of the insertion of the Midline catheter. Of note, I am overwhelmingly biased in favor of these devices and have taken such a fanciful liking to […]
EMCrit 132 – MoTR – Toughness Part I with Michael Lauria
Today, I interview Mike Lauria on the concepts of toughness and resilience.
Double-coverage of gram negatives with a fluoroquinolone?
0 Introduction 0 The benefit of empirically using two antibiotics to cover gram negative bacilli is a perpetual controversy. For patients in septic shock, failure to provide effective initial antimicrobial therapy correlates with increased mortality. Using two drugs may increase the likelihood of an including at least one antibiotic which covers the pathogen. This […]
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