Anyone who has spent some time in a cardiac intensive care unit understands the physiologic appeal of the intra-aortic balloon pump (IABP). Anecdotally its use improves multiple clinical endpoints that for years have been considered surrogates for patient important outcomes. And yet, despite these physiologic advantages when examined in a rigorous fashion, IABPs have failed to … [Read more...]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Failed Assumptions
Whether you are aware of it our not, three major assumptions are present when employing any diagnostic strategy in the Emergency Department. First, that the diagnostic test in question will identify a group of patients at risk of a poor outcome due to an otherwise undiagnosed process. Second, there is an effective therapeutic intervention that will avert said outcome. And … [Read more...]
EM Nerd-A Case of Shadows Continues
The use of point of care ultrasound (POCUS) in the Emergency Department is a Bayesian playground for those willing to indulge. Take for example the performance of POCUS in the diagnosis of pulmonary embolism (PE).The poor sensitivity of bedside echocardiography to identify all-comers with pulmonary embolism is well documented. Most series cite a sensitivity and specificity … [Read more...]
EM Nerd-The Case of the Tardy Delegate
We have discussed the dangers of surrogate outcomes at length, but none are more evident to an Emergency Physician than the time-based metrics we are subjected to on a daily basis. The latest of these temporal surrogates forced upon us is the 3-hour bundle of care in patients presenting to the Emergency Department with symptoms concerning for sepsis. In a recent article … [Read more...]
CC Nerd-The Case of the Anatomic Inaccuracy
A recent publication in Chest by Semler et al examined the utility of the ramped position for the emergent intubation of patients in the ICU (1). The results not only call into question our use of this technique, but more importantly the outcomes we use to evaluate the efficacy of airway interventions outside the pristine environment of the operating room.The authors … [Read more...]
Hi, my name is Scott Weingart.