The process of rapid sequence induction (RSI) often forces the clinician to choose between two conflicting priorities. Torn between maintaining a safe level of oxygen, rendering the patient apneic, and limiting the amount of positive pressure ventilatory support given prior to obtaining a secure airway in the hopes of minimizing the risk of aspiration. Traditionally […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Deceitful Lantern
Since the publication of the sepsis trilogy, PROMISE, ARISE, and PROCESS 1,2,3, abruptly displaced early goal directed therapy (EGDT) as the cornerstone of sepsis management, we have been searching to fill the therapeutic vacuum its sudden departure left behind. The Center for Medicare and Medicaid Services (CMS) and the Surviving Sepsis Campaign (SSC) have both rushed […]
The Case of the Scientific Ruse
February 7th 2019 marked a auspicious day in the history of the NEJM and its relationship with the pharmaceutical industry. In 2015, the NEJM shifted their significant weight in support of a strong union between industry and medicine1,2,3. With the simultaneous publication of four pharmaceutical sponsored trials, each brimming with its own unique form of […]
The Case of the Incidental Bystander Continues
In October 2016 the Emergency Medicine community was faced with the publication of the now infamous PESIT trial, and the symbolic wrench its authors carelessly tossed into the already indecisive diagnostic work up of patients presenting to the Emergency Department following a syncopal event1. Published in the NEJM, Prandoni et al enrolled patients who were admitted […]
The Case of the False Dichotomy
Often in the interpretation of medical literature we are forced into false dichotomies. Compelled to choose between two hypotheses, neither of which are representative of the data presented. Such is the case with a recent trial published in Intensive Care Medicine in which Guitton et al1 examine the efficacy of apneic oxygenation during RSI in critically […]
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