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 […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
CC Nerd-The Case of the Inverted Premise
No mode of ventilation is burdened with more emotional baggage than airway pressure release ventilation (APRV). The mere suggestion of its use is met with either the delight of recognizing an old friend whom you are meeting for the first time, or the type of disgust typically reserved for the likes of snake oil salesmen. […]
CC Nerd-The Case of the Relative Insufficiency
When it comes to the efficacy of glucocorticoid therapy for the treatment of septic shock, we have existed in a state of ambiguity, torn between the results of two contradictory RCTs. The first, the Annane et al trial published in JAMA in 2002, suggested a mortality benefit in favor of the corticosteroid group in the […]
EM Nerd-The Case of the Aimless Convoy Continues
Evidence has consistently demonstrated the lack of clinical utility provided by natriuretic peptides. Further studies documenting their incompetencies are no longer necessary, but it is rather enjoyable to highlight their dependable failures. The most recent illustration of natriuretic peptides clinical ineptitude was published this week in CIRCULATION by Stienen et al (1). The authors randomized […]
EM Nerd-The Case of the Tardy Delegate Continues
In 2000 Fazzini et al published a paper comparing the use of ionization vs photoelectric smoke alarms in rural Alaskan homes (1). The authors noted that at the time of the article’s publication. the fire fatality rate for native Alaskans was 9.6 times the national rate and 3.5 times higher than the general rate in […]