When it comes to non-traumatic intracranial hemorrhage (ICH) the onus of the emergency physician is diagnosis, while location and severity are of far less importance. Once the diagnosis is made and the initial stabilization complete, there is very little for us to do other then notify the ICU team and contact the neurosurgeon, who, in […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
The Adventure of the Greek Interpreter
In Greek mythology Peitho was the Goddess of persuasion and seduction. Please feel free to find irony where you see fit… I am a sucker for catchy trial names. I swoon in anticipation when reading of the recent publication of a large multi-centered randomized control trial on a topic that is relevant to emergency medicine. […]
The Adventure of the Cardboard Box
There have been a number of seemingly negative studies published recently in which the authors, using ordinal analysis, have claimed their trials are in fact positive. Though not the first, the most notable of these studies was the IST3 trial published in May of last year. In this trial, the largest to date, comparing thrombolytics […]
The Case of The Dying Detective…
…and his missing lactate I am, as I am sure many of you are, a big fan of using lactate to guide my resuscitative efforts in my critically ill septic patients. You would pour fluids into your large bore catheters, infuse pressors through your ultrasound guided central lines and revel in how quickly you […]
The Sign of Four…
…Factors that is. On April 23rd 2013, the FDA approved CSL Behring’s product Kcentra as the first 4-Factor Prothrombin Complex Concentrate (PCC) available in the United States for the use in treatment of anti-coagulated patients with acute hemorrhage. 4- Factor PCC has been widely available in Europe and Canada for years, but the FDA wanted […]