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 […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
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 […]
CC Nerd-The Case of the Neutral Documents
A brief editorial aside: Both Josh and Scott have commented on the BICAR-ICU Trial in previous posts, each presenting well thought out erudite analyses. I recommend reading/listening to them. EMCrit: Acid Base Episode 7 PulmCrit: pH-guided fluid resuscitation & BICAR-ICU The overwhelming need for euboxia has inspired a multitude of therapeutic endeavors, including the use of […]
EM Nerd-The Case of the Deceptive Beacon
Let’s face it, we have an unhealthy relationship with antibiotics. We are all aware that we are currently in an antibiotic resistance crisis that is driven by overuse. And despite our enlightenment we cannot seem to stop prescribing antibiotics for complaints that have been clearly shown not to require antibiotics. And so, given our appalling […]
EM Nerd-The Peculiar Case of the Parallel Pathways
So rarely is a study published that directly and effortlessly translates into clinical practice. Very few of these studies examine the nuances of everyday practice in the fast paced milieu of the Emergency Department. Given the infrequency of such studies, I am continually amazed by the work put forth by Brian Driver and colleagues at […]