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 […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
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 […]
EM Nerd-The Case to the Ecological Ambiguity
With each publication from Maitland et al we are granted a brief glimpse of a greater medical truth. Only our view is obstructed, as we peer through the constricted aperture created by the questions regarding its external validity. In 2011, Maitland et al published the FEAST trial in the NEJM (1). This landmark trial called […]
The Case of the False Imprisonment
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 […]
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