On September 9th 2013 the article we have all been eagerly awaiting (or perhaps just myself!), was published in Circulation by Sarode et al (1). What was formerly known as Trial 3002 was officially named “Efficacy and Safety of a 4-factor Prothrombin Complex Concentrate in Patients on Vitamin K Antagonists Presenting with Major Bleeding”. Surprisingly […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
The Case of the Thirteen Watches
Door-to-balloon time is probably the most overstated, but least understood surrogate outcome measured in Emergency Medicine today. No sooner does the patient with midsternal chest pressure and ST elevations set foot in the emergency department, when they are packaged up and swept away to the cath lab by a gang of cardiology fellows and attendings. Now with […]
A Case of Identity
On August 17th 2013 The Lancet published what appears to be Eli Lilly’s face saving article on its derailed quest to replace its predecessor, clopidogrel (1).In its attempt to emulate Bristol Meyer with its triple C (CURE, CREDO, CLARITY) trials, pull the wool over the healthcare industry’s global eyes and become the second leading sold drug […]
The Adventure of the Crooked Man
A recent study entitled, “Outcomes at 12 Months After Early Magnetic Resonance Imaging in Acute Trauma Patients With Persistent Midline Cervical Tenderness and Negative Computed Tomography” published in the June 2013 issue of Spine has attempted to shine a small amount of light on a topic that has cast a large shadow of doubt on […]
The Adventure of the Red Circle
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 […]