Lung-protective ventilation is often considered a simple truth when managing critical care patients on mechanical ventilation. Despite this sense of certainty, the knowledge of exactly how and when to perform such ventilatory strategies is incomplete. The recently published PReVENT adds yet more uncertainty to the true efficacy of low tidal volume ventilation in patients without […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
CC Nerd-The Case of the Subjective Truth
A recent post examining the utility of cricoid pressure and how to interpret non-inferiority trials stimulated discussion on Bayesian analysis and the question of whether a formal quantitative analysis is necessary or if an informal qualitative assessment is adequate. A recent reanalysis of the EOLIA trial published in JAMA by Goligher et al1 allows us to […]
EM Nerd-The Case of the Inferior Superiority
A perfect trial would require minimal statistical tools to assist in its analysis. Such a trial would be so large that the sample approached the true likeness of the broader population it intended to emulate, thus the risk of sampling error would be minimal. The confidence intervals surrounding the point estimates would be so minute, […]
EM Nerd-An Addendum to the Case of the Non-inferior Inferiority
Until recently the management of acute appendicitis has lay squarely in the hands of the surgeon. But there is a growing body of evidence examining the use of antibiotics alone in uncomplicated appendicitis. Most of the data exploring this question has found that the majority of patients treated with antibiotics alone will avoid surgery in […]
EM Nerd-The Case of the Anatomic Heart Revisited
If Maslow were to generate a hierarchy of needs to assess the utility of the coronary CT angiogram (CCTA) in the Emergency Department for the evaluation of chest pain it would look something like this: We have fairly robust data demonstrating the use of CCTA does not improve mortality, nor does it decrease the rate […]
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