The total-body CT (typically referred to as the pan-scan) has quickly become a key component in the initial evaluation of trauma patients presenting to the Emergency Department. Despite this, the evidence supporting the benefits of the trauma pan-scan is lacking. Its rise to prominence due more so to riotous indignation than true evidentiary support. This […]
EMNerd
The Nihilistic Ramblings of Rory Spiegel, MD
CC Nerd*-The Case of the Afflicted Kidney
Recently two trials examining the efficacy of the early utilization of renal replacement therapy (RRT) in critically ill adults with acute kidney injury (AKI) in the ICU were published. Despite examining very similar patient populations, undergoing very similar modes of therapy, these trials produced drastically divergent results. The following is a brief exploration of each […]
EMNerd-The Case of the Differing Perspectives
The reversal of medical truth is not an uncommon occurrence in today’s world of gullible frequentist methodology. Upon examination of a decade’s worth of publications from the NEJM, Prasad et al found that of the trials examining an established medical practice, 40.2% contradicted the initial data responsible for these medical beliefs. This in part is […]
EMNerd – The Case of the Unmasked Rival
NIPPV with Full Face Mask for ARDS
The Case of the Non-inferior Inferiority Continues
Low-Dose tPA
The Case of the Indiscriminate Waveform
From the very start of our Residency training, Emergency Medicine Physicians are tasked with committing to memory the correctable causes of PEA arrest. It is expected any intern worth their salt should be able to recite the H’s & T’s proselytized by the AHA as far back as 1995 (1). And yet, it quickly becomes […]
The Case of the Man Made of Straw
So often when interpreting the medical literature, success is determined by how you define it. Such is the case with a recent article on the management of pain due to ureteral colic. Published in the Lancet in 2016, Pathan et al examined the efficacy of IM diclofenax, IV acetaminophen, or IV morphine in treating the […]
The Case of the Perfect Imperfection
The Enemy of Good is Perfect The interpretation of literature is not dissimilar from the interpretation of the Rorschach tests. To one person the data appears to be a freshly hatched butterfly full of hope and promise. While to another it is a discomforting stain resulting from the splatter of improperly handled bodily excrement. What you […]
A Case of Shadows Part II
I think we all can agree that the subtleties of the thoracic cavity go far beyond the diagnostic capabilities of our standard two-view chest x-ray. We have robust data that demonstrates the superb diagnostic prowess of bedside ultrasound (US) when compared to the mediocrity of plain films (1, 2,3,4). And yet more information is not […]
The Case of the Pragmatic Wound
The clinical milieu of the Emergency Department is far from straightforward. The cognitive grime in which we function is rarely conducive to the pristine distinctions drawn by Evidence-Based Medicine (EBM). As such we are often asked to make dichotomous decisions based off a single study, using answers to questions we never intended on asking. Until […]
The Case of the Anatomic Injury
It is not uncommon for the standard of care to be dictated by those who speak the loudest rather than a representative sample of best medical practice. This is certainly the case with the inclusion of whole-body CT scans in the initial management of patients presenting to the Emergency Department with traumatic complaints. Known […]
The Case of the Precise Inaccuracy
In the world of medical science we are often lulled into a false sense of security by large sample sizes and their correspondingly small confidence intervals. We often forget that such methodologic strengths augment only a trials precision, or the likelihood a similar trial will produce similar results. Such statistical robustness speaks little towards a […]
EMNerd – More on the FELLOW Trial
A methodological take on the FELLOW trial
The Adventure of the Cardboard Box Revisited
Meta-analyses function under the assumption that the summation of data from multiple sources is a more accurate estimate of the true effect size than any one individual trial. And yet sometimes such statistical endeavors serve only to add dirt to the already muddy water. Such is the case with the recent trials examining endovascular therapy […]
The Case of the Blind Allocator
In the modern world of evidence based medicine we exist in a perpetual state of doubt, continually attempting to perceive truths through the veil of science. Far too often our sample cohort deviates from the population it intends to represent. Hypothesis testing and frequentist statistics are tools intended to quantify the extent to which the […]
- « Previous Page
- 1
- …
- 4
- 5
- 6
- 7
- 8
- …
- 10
- Next Page »