The October 2016 NEJM publication of the PESIT trial by Prandoni et al set the world of social media ablaze (1). There were the standard fear mongering headlines noting that 1 in 6 patients admitted to the hospital following syncope had a pulmonary embolism. This was followed by a reactionary flurry of commentary by the FOAM community explaining why these results were likely a … [Read more...]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Bridge to Nowhere
The use of mechanical cardiopulmonary resuscitation (mCPR) has been a polarizing topic almost from its inception. The idea, a simple one. Why not build a machine that is capable of doing perfect chest compressions? A simple, effective way to eliminate the inconsistencies common to manual chest compressions. And yet, despite building a number of devices that are capable of … [Read more...]
EM Nerd-The Case of the Shadowy Spector
The shadow of the long-term sequelae of submassive pulmonary emboli has stalked the hearts and minds of Emergency Physicians. The use of thrombolytics to prevent these ramification has previously been supported primarily with surrogate data, physiological reasoning and communal anecdotal experience. Thrombolytics for submassive pulmonary emboli have failed to demonstrate an … [Read more...]
EM Nerd-A Brief Addendum to the Adventure of the Red-Headed League
What is the clinical significance of a post traumatic seizure (PTS) in children presenting to the Emergency Department following minor head trauma?This is a question surrounded by myth and dogma. As with most questions regarding traumatic brain injury (TBI) in children, the PECARN authors have come to our aid.Badawy et al published a secondary analysis of the massive … [Read more...]
EM Nerd-The Case of the Inconsequential Truth
There have been a number of publications recently maligning the use of morphine for the treatment of acute coronary syndrome (ACS). The hypothesis proposed is that morphine slows the absorption of the oral p2y12 inhibitors, such as ticagrelor, delaying the dual- platelet inhibition desired by cardiologists worldwide.The most recent data supporting this hypothesis was … [Read more...]
Hi, my name is Scott Weingart.