The guiding physiological principles of resuscitation have for so long been based off the restoration of normal macroscopic hemodynamics in the hopes that the reversal of such circulatory perturbations will correct the underlying cellular injustices. And yet time after time such strategies have failed to show definitive benefits when empirically tested. The simple … [Read more...]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-The Case of the Liberated Radicals
A recent publication in the NEJM by Hofmann et al (1) serves as a nice reminder that so many of our therapeutic staples while based on sound physiological reasoning fail to translate into clinically important realities when empirically tested.This mammoth undertaking, entitled the DETO2X trial, randomized 6629 adult patients (>30 years old) presenting to 35 hospitals in … [Read more...]
The Case of the Aimless Convoy
Never has a biomarker with so much evidence demonstrating its disutility, enjoyed such a long reign of prosperity as BNP and its natriuretic analogs. And while evidence discrediting BNP’s use for the diagnosis and inpatient management of acute exacerbations of heart failure (HF) is well documented, its utility to guide outpatient therapy in patients with HF has not … [Read more...]
EM Nerd-The Case of the Elemental Truancy
Much has been written regarding the benefits of apneic oxygenation. The physiological underpinnings are sound with minimal logistical and resource based costs. As such it has enjoyed widespread adoption throughout the Emergency Medicine and Critical Care world. Despite its popularity, the evidence supporting its use has been less inspirational.Recently, a meta-analysis … [Read more...]
EM Nerd-The Case of the Bridge to Nowhere Continues
So often we apply qualitative dichotomies to quantitative differences even when questionable clinical distinction exists. Such is the case with the general interpretation of a recent article published in Resuscitation.Huis in ’t Veld et al examined video recordings of real life Emergency Department resuscitations of patients in cardiac arrest (1). Over a one year period 23 … [Read more...]