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

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EMNerd

The Nihilistic Ramblings of Rory Spiegel, MD

The Adventure of the Cardboard Box

June 30, 2013 by Rory Spiegel 6 Comments

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…

June 12, 2013 by Rory Spiegel 3 Comments

…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…

May 20, 2013 by Rory Spiegel 4 Comments

…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 […]

The Status on Status

April 29, 2013 by Rory Spiegel 1 Comment

You do not have to be an Emergency Physician for very long before you encounter your first case of status epilepticus. You are taught early in your career of the well known pathway of how to treat status. Thankfully most cases of status do not progress further down this pathway than your initial intervention. For […]

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