I walk into the room and see a 3 year old screaming in pain. It’s 3 am and her ear hurts. She couldn’t sleep. I ask her father what he has been using at home for pain. He pulls out a box and my heart sinks. Another parent duped by […]
Here is another collection of the articles I have found interesting in my reading from the last month or so. For this edition of the Research Roundup we have status epilepticus, nocebos, the pink lady, McGyver bias, and so much more. Podcast version over on BroomeDocs.
This will be the final post this week about status epilepticus. I have long argued that our current status algorithms leave too many patients seizing for too long. I updated my suggested alternative algorithm this week and added a longer supplemental post explaining the reasons that I suggest early anesthetic […]
My approach to status epilepticus is somewhat more aggressive than commonly taught algorithms. It is summarized (overly simply) as “benzo → benzo → propofol”. There have been a number of concerns raised with this strategy recently on twitter. This post outlines the reasoning (and limited evidence) behind my seizure algorithm.
Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. The seizure has lasted at least 12 minutes now, so this is status epilepticus. No information is available about her past history. The paramedics were unable to start an IV, but did […]
Hemoptysis can be scary. I covered the emergency medicine approach to massive hemoptysis in one of the early posts on First10EM. However, even when the hemoptysis is small volume, it can be quite distressing to patients and clinicians alike. This paper asks whether using nebulized tranexamic acid (or TXA) for […]
The “pink lady” or “GI cocktail”, a combination of an antacid and viscous lidocaine, is both much loved and much hated in emergency medicine. Some practitioners use it as a matter of routine. Others warn against it, for fear that it can lead to misdiagnosis in the setting of MI. […]
Last week, I discussed the reasons that I believe that tramadol is a bad drug that shouldn’t be prescribed. This week, I will tackle a similarly bad drug: codeine. The argument is essentially the same. Tramadol may be moderately worse, because of the added SNRI effects, but the variable effects […]
I have never prescribed tramadol. I was taught that, for a variety of reasons, it’s an awful drug. In Canada, everyone seemed to agree. But then I moved to New Zealand.