Inadvertent catastrophes are often hidden just beneath good intentions. Such is the case with the most recent iteration of the Surviving Sepsis Campaign’s treatment bundle. Published in Intensive Care Medicine by Levy et al, this special editorial includes the Surviving Sepsis Campaign’s most recent recommendations for the early and aggressive treatment of sepsis (1). Most […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
EM Nerd-Behind the Veil of Science
On March 26th 2018, the New York Times published an article by Gina Kolata, For Many Strokes, There’s an Effective Treatment. Why Aren’t Some Doctors Offering It?, examining the efficacy of tPA in acute ischemic stroke. The article was dismissive and misleading. In response, I sent a letter to the editor which I fear […]
CC Nerd-The Case of the Unbalanced Solution
The use of 0.9% saline has undergone a degree of scrutiny in recent years. Detractors claim high chloride content, leads to acidosis and kidney injury. But clinical evidence supporting the clinically deleterious effects is lacking. The SPLIT Trial published in JAMA in 2015 by Young et (1) al failed to find any difference in outcomes […]
EM Nerd-The Case of the Diagnostic Absurdity
Is it just me or have we lost our collective minds? A recent trial published in JAMA, by Freund et al (1), illustrates just how far our diagnostic psychosis has progressed. The authors conducted a crossover cluster–randomized non-inferiority trial examining a strategy utilizing the pulmonary embolism rule out criteria (PERC) rule to rule out pulmonary […]
CC Nerd-The Case of the Inverted Premise
No mode of ventilation is burdened with more emotional baggage than airway pressure release ventilation (APRV). The mere suggestion of its use is met with either the delight of recognizing an old friend whom you are meeting for the first time, or the type of disgust typically reserved for the likes of snake oil salesmen. […]