A recent publication in the NEJM by Hofmann et al (1) serves as a nice reminder that so many of our therapeutic staples while based on sound physiological reasoning fail to translate into clinically important realities when empirically tested.This mammoth undertaking, entitled the DETO2X trial, randomized 6629 adult patients (>30 years old) presenting to 35 hospitals in … [Read more...]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
The Cause of the Aimless Convoy
Never has a biomarker with so much evidence demonstrating its disutility, enjoyed such a long reign of prosperity as BNP and its natriuretic analogs. And while evidence discrediting BNP’s use for the diagnosis and inpatient management of acute exacerbations of heart failure (HF) is well documented, its utility to guide outpatient therapy in patients with HF has not … [Read more...]
EM Nerd-The Case of the Elemental Truancy
Much has been written regarding the benefits of apneic oxygenation. The physiological underpinnings are sound with minimal logistical and resource based costs. As such it has enjoyed widespread adoption throughout the Emergency Medicine and Critical Care world. Despite its popularity, the evidence supporting its use has been less inspirational.Recently, a meta-analysis … [Read more...]
EM Nerd-The Case of the Bridge to Nowhere Continues
So often we apply qualitative dichotomies to quantitative differences even when questionable clinical distinction exists. Such is the case with the general interpretation of a recent article published in Resuscitation.Huis in ’t Veld et al examined video recordings of real life Emergency Department resuscitations of patients in cardiac arrest (1). Over a one year period 23 … [Read more...]
EM Nerd-An Addendum to the Case of the Tarnished Standard
In a previous post we discussed the use of IVC variation and the concept of fluid responsiveness. Despite a strong physiological basis, no studies examining the use of fluid responsiveness to guide resuscitative efforts in patients with septic shock have been shown to improve patient important outcomes. Shortly after this post was released, Critical Care Medicine published an … [Read more...]
Hi, my name is Scott Weingart.