The management of sepsis has evolved dramatically since I was a trainee, just after Manny Rivers published his seminal sepsis protocol. At this point, I think we mostly know what we are doing. We give antibiotics. We look for a source and get source control. We give some fluids, but […]
All posts
513 posts
Personally, I find the normal saline versus balanced fluid debate pretty boring. I don’t really care which you choose. It seems incredibly unlikely that your choice of crystalloid will have any clinical impact on patients. I use saline, but I don’t really have a strong opinion. I don’t think anyone […]
One reason that clinical judgement regularly beats decision rules is that decision rules (at least as they are currently designed) are forced to use arbitrary cut-offs. Imagine you develop a little bit of pleuritic chest pain during your 50th birthday dinner. Head straight to the hospital while you are still […]
The use of heparin in acute coronary syndrome was one of the primary gateways into my hatred of guidelines. Medical guidelines contain a lot of recommendations that aren’t exactly evidence based. When you dig into the evidence for heparin in NSTEMI, it becomes pretty clear that it shouldn’t be used, […]
Does N95 mask fitting really require you to me clean shaven? Might the practice actually be making you less safe?
The June 2026 First10em #FOAMEd Research Roundup Featuring appraisals of high quality recent RCTs, and for some reason Neanderthal dentistry
Strike 2 against whole blood. This time, mortality was 5% higher (but statistically negative) when whole blood was used in the prehospital setting. The TOWAR study
One of the downsides of subscribing to more than 50 journal feeds is the huge number of interesting papers that I flag for later, but never find time to fully appraise. I have been clearing some of these old PDFs out of my computer, but I figured that if the […]
It should be the easiest patient of the day. It is just a sore throat. The patient is fine. No signs of epiglottitis or deep space infection. They are clearly going home. But you are working with a curious student, and their questions unearth a tremendous amount of uncertainty. How […]