Since Hector Pope published his now infamous study in the April 2000 NEJM, Emergency Physicians ability to clinically differentiate ACS has been called into question(10). Despite the fact the study’s findings that ED physicians missed an almost flawless 0.18% of chest pain patients who went on to be diagnosed with a MI, we have been […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
The Man with the Twisted Lip
As an Emergency Medicine doctor we are trained to function in varying degrees of uncertainty. We work in a world of risk of benefits vs harms. When the benefit to harm ratio reaches a threshold for action we are taught to do so swiftly and decisively. Given this, […]
The Adventure of the Three Students
There are few things that make emergency medicine nerds more excited than decision rules. So when the Canadian gods of decision instruments, Jeff Perry and Ian Stiell, published the results from the validation cohort of their recently derived SAH decision rules they of course had our full attention. On September 25th 2013 JAMA published this […]
The Sign of Four Part 2
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 […]
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 […]