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EMNerd (EMCrit)

Online Medical Education on Emergency Department (ED) Critical Care, Trauma, and Resuscitation

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EMNerd

The Nihilistic Ramblings of Rory Spiegel, MD

EM Nerd-The Case of the Hurried Objective

October 8, 2019 by Rory Spiegel 2 Comments

In 2015, Centers for Medicare & Medicaid (CMS) published their sepsis core measure (SEP-1). This represented a nationally mandated sepsis management strategy presented in the form of a 3 and 6-hour bundle. Since its publication, the Surviving Sepsis Campaign (SSC) released their own 1-hour bundle (1), adding even more urgency to an already frenetic effort […]

EM Nerd-The Case of the Sour Remedy

October 4, 2019 by Rory Spiegel 2 Comments

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 […]

EM Nerd-The Case of the Microscopic Imperative

September 19, 2019 by Rory Spiegel 2 Comments

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

September 5, 2019 by Rory Spiegel 2 Comments

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

August 9, 2019 by Rory Spiegel 3 Comments

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 […]

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