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 […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Erroneous Humour
Since the NEJM publication by Pope et al in 2000 found 2% of patients with myocardial infarctions were discharged home from the Emergency Department, we have been in search of a tool capable of identifying a cohort of patients who are truly safe for discharge1. Many have anointed the high-sensitivity troponin assay (hs-cTnI) to this […]
EM Nerd-The Case of the Needless Imperative
Airway has been paramount to the management of cardiac arrest since the earliest endeavors in resuscitation. The use of tobacco smoke enemas to resuscitate drowning victims on the banks of the Thames was documented as far back as 17461. Such efforts while anatomically misplaced, were in principle well intended. Although, we have since discovered alternative […]
EM Nerd-The Case of the Costly Compound
Epinephrine has been a fundamental therapeutic agent in the management of cardiac arrest since the inception of advanced life support. Despite its ubiquitous use, this practice has never been supported by high quality evidence. With the publication of the PARAMEDIC-2 trial by Perkins et al1, we are now far closer to understanding the true value […]
EM Nerd-The Case of the Missing Comparator
Since the publication of NINDS, a large number of registry based observational studies have been used for the weaponization of tPA in the clinical setting. Initially utilized to justify the use of tPA outside the controlled setting of a clinical trial, and later used to support the profitable indication creep we have observed in the […]