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 the Hennepin County Emergency … [Read more...]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Temporal Fallacy
Inadvertent catastrophes are often hidden just beneath good intentions. Such is the case with the most recent iteration of the Surviving Sepsis Campaign’s treatment bundle.Published in Intensive Care Medicine by Levy et al, this special editorial includes the Surviving Sepsis Campaign’s most recent recommendations for the early and aggressive treatment of sepsis (1). Most … [Read more...]
EM Nerd-Behind the Veil of Science
On March 26th 2018, the New York Times published an article by Gina Kolata, For Many Strokes, There's an Effective Treatment. Why Aren't Some Doctors Offering It?, examining the efficacy of tPA in acute ischemic stroke. The article was dismissive and misleading. In response, I sent a letter to the editor which I fear will never see the light of day. What follows … [Read more...]
CC Nerd-The Case of the Unbalanced Solution
The use of 0.9% saline has undergone a degree of scrutiny in recent years. Detractors claim high chloride content, leads to acidosis and kidney injury. But clinical evidence supporting the clinically deleterious effects is lacking. The SPLIT Trial published in JAMA in 2015 by Young et (1) al failed to find any difference in outcomes for patients who received crystalloid … [Read more...]
EM Nerd-The Case of the Diagnostic Absurdity
Is it just me or have we lost our collective minds?A recent trial published in JAMA, by Freund et al (1), illustrates just how far our diagnostic psychosis has progressed.The authors conducted a crossover cluster–randomized non-inferiority trial examining a strategy utilizing the pulmonary embolism rule out criteria (PERC) rule to rule out pulmonary embolism (PE). The … [Read more...]