I have written fairly extensively about the management of high risk PE. Despite their growing popularity, I have remained quite skeptical of catheter directed therapies. If you are going to give a thrombolytic, my sense is that it is going to be just as effective if given through a peripheral […]
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Although guidelines have long suggested higher blood pressure targets in spinal cord injury, that recommendation has never been based on high quality evidence. (Walters 2013; Sanchez 2020) (This is the first ever RCT.) We have a bad habit of treating numbers in medicine, and often making things worse. (Remember the […]
At this point, most people in the emergency medicine and critical care worlds just assume that balanced (ie, 1:1:1) transfusion is a proven intervention, and the focus has mostly moved on the the potential of whole blood. I am in an almost nonexistent minority when I argue that balanced transfusion […]
Classic medicine: running high cost RCTs that are too small to give real answers Préterre C, Gaultier A, Obadia M, Vignal C, Mourand I, Plat J, Sablot D, Gaudron M, Rodier G, Godeneche G, Urbanczyk C, Marc G, Massardier E, Adam S, Boulanger M, Marcel S, Mechtouff L, Ronzière T, […]
Dynamic left ventricular outflow tract obstruction (LVOTO) is not a condition I learned about during residency, and it is not a condition I have diagnosed regularly, although I have probably missed it many many times. On First10EM, I usually prefer to start with a presenting symptom than a diagnosis, because […]
Most resuscitation is pretty straightforward. No matter how sick the patient is, we select from a fairly limited list of interventions. Hypoxia: does the patient need facemask oxygen, highflow, BiPAP, or intubation? Hypotension: fluids, blood, vasopressors? This basic, well used menu serves us incredibly well for the vast majority of […]
After more than a decade on the job, it feels like I should have this emergency medicine thing figured out, but that just doesn’t seem to be how things work. There are constantly new presentations; patients that provoke new questions. However, I find it incredibly disconcerting when something is time […]
The big paper of the month: ketamine vs etomidate for RSI Casey JD, Seitz KP, Driver BE, et al. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2025 Dec 9. doi: 10.1056/NEJMoa2511420. Epub ahead of print. PMID: 41369227 On its face, this is a […]
There are many different approaches to stable patients with atrial fibrillation who present to the emergency department. Personally, I have leaned towards electrical cardioversion over chemical cardioversion in patients in whom cardioversion is appropriate. In the places I work, it is usually faster and easier to get a patient sedated […]