In the FOAM community a great deal of time is spent discussing the appropriate manner of transitioning critically ill patients onto mechanical ventilation. A far larger portion of the practice of critical care is spent determining how best to liberate our patients from the ventilatory shackles with which we have bound them. The specifics of […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
CC Nerd-The Case of the Needless Blockade
A recent post on the EXTEND Trial stimulated a passionate debate regarding the use of adjusted analysis in RCTs. A number of of those partaking in this discussion argued feverishly for the use of adjusted analysis in RCTs, and made very strong arguments in favor of such methods. I argued that while adjusted analyses […]
The Case of the Magician’s Sleight
Since the earliest trials examining the efficacy of tPA for acute ischemic stroke there has been a tendency to play it fast and loose with the scientific method. The results of the landmark NINDS-2 trial (1), a moderate sized RCT, with a tenuously positive primary outcome (Fragility Index of 3), were never validated. The results […]
EM Nerd-The Case of the Irregular Irregularity Continues
Very little about the management of atrial fibrillation is an emergency. And yet we in the Emergency Medicine community have embraced it as such. We gleefully bring to bear the full technological powers available to an Emergency Physician in our attempts to tame its irregular irregularity. Using this aggressive approach, we have proven ourselves quite […]
EM Nerd-The Case of the Conspicuous Conclusion
The process of rapid sequence induction (RSI) often forces the clinician to choose between two conflicting priorities. Torn between maintaining a safe level of oxygen, rendering the patient apneic, and limiting the amount of positive pressure ventilatory support given prior to obtaining a secure airway in the hopes of minimizing the risk of aspiration. Traditionally […]
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