Studies examining the use of tranexamic acid (TXA) inescapably seem to pit our methodological rigorous demons against our practical clinical angels. The CRASH-2 trial published in the Lancet in 2010 by Shakur et al, randomized 20,211 adult trauma patients presenting to 274 hospitals in 40 different countries to receive 1g of TXA over 10 min […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Hurried Objective
In 2015, Centers for Medicare & Medicaid (CMS) published their sepsis core measure (SEP-1). This represented a nationally mandated sepsis management strategy presented in the form of a 3 and 6-hour bundle. Since its publication, the Surviving Sepsis Campaign (SSC) released their own 1-hour bundle (1), adding even more urgency to an already frenetic effort […]
EM Nerd-The Case of the Sour Remedy
In 2017 Marik et al (1) published an observational before and after study examining the initiation of the sepsis cocktail for ICU patients admitted with sepsis. The authors noted, following the introduction of this cocktail, which included IV vitamin C, thiamine and hydrocortisone, ICU mortality dropped by an extraordinary 31.9% (40.4% to 8.5%). Since this […]
EM Nerd-The Case of the Microscopic Imperative
In the management of sepsis, the acquisition of blood cultures prior to the administration of antibiotics has been a long-held dictum, even before it gained the regulatory support due to its place in the SEP-1 3-hour bundle. But how much is lost if we defer the acquisition of blood cultures until after the administration of […]
EM Nerd-The Case of the Optical Misperception
Whether we like it or not, high-sensitivity troponin assays, recently approved by the FDA, will soon replace the 4th generation assays currently in operation. And while many claims have been made regarding their clinical utility, the implications for our standard chest pain workflow are unclear. A recent publication by Chew et al, provides us a […]
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