Embedding decision tools into the electronic record

Last week I picked up a chart at work. It was a 25 year old woman who had sneezed very hard and developed some right sided rib pain. She had waited about 2 hours to see me after being sent in from a walk in clinic with a note asking me to “rule out PE” because the pain was, unsurprisingly, pleuritic. She had normal vital signs. She had an x ray done at the walk in clinic that ruled out pneumothorax. She had no history of or risk factors for VTE. She had a Well’s score of 0. She was PERC negative. Continue reading “Embedding decision tools into the electronic record”

Interventional therapy for acute ischemic stroke: the evidence

A summary of the evidence for endovascular therapy in stroke

In part 2 of our EM Cases Journal Jam, we explored the literature looking at endovascular therapy for acute ischemic stroke. (Part 1 on the evidence for thrombolytics can be found here.) The studies of interventional therapy for stroke tend to get broken down into the early (negative) studies and the later (positive) studies. For consistency, I’ll use the same break down. Continue reading “Interventional therapy for acute ischemic stroke: the evidence”

Articles of the month (June 2017 – #dasSMACC edition)

This month’s articles are a little special. Usually, I pick out the articles that catch my eye, but it’s easy to imagine that my biases filter out a lot of interesting medical literature. As there were a number of experts descending on Berlin this month for SMACC, Casey Parker and I invited a few people to suggest a paper and discuss it with us over a beer for our podcast. The conversation was great, and can be found here. These are the articles that were picked:

Continue reading “Articles of the month (June 2017 – #dasSMACC edition)”

Embracing Science: #dasSMACC Hardcore EM handout

A handout for the EBM portion of the Hardcore EM seminar at #dasSMACC

Continue reading “Embracing Science: #dasSMACC Hardcore EM handout”

Articles of the month (May 2017)

I took another month off, but the blog and accompanying podcast are back with what I think is an interesting collection of articles… Continue reading “Articles of the month (May 2017)”

Thrombolytics for stroke: The evidence

A summary of the evidence for (or against) thrombolytics for stroke

Thrombolytics for stroke: undoubtedly the biggest controversy in emergency medicine. Also, the topic of this week’s Emergency Medicine Cases Journal Jam podcast. Rory Spiegel, Anton Helman, and I take a deep dive into the evidence. Why would we do this? No, it isn’t just that we have too much time on our hands. The journal jam podcast exists because we truly believe it is important to understand why we do what we do, both to ensure we are always providing the best care for our patients, but also so that we can explain that care to our patients. The evidence for (or against) thrombolytics is important precisely because the topic is so controversial. You will hear arguments on both sides. So will your patients. It is only through a familiarity with the studies, their strengths, and their weaknesses, that you will be able to decide for yourself what the evidence really shows and guide your patients to the best decision for their circumstances.

What follows are the notes I made while preparing for the podcast. First, I review the major randomized controlled trials looking at thrombolytics for stroke. That is followed by a discussion of the things I think are important to consider when trying to interpret this data. (Many folks might want to skip straight to this discussion section.) Continue reading “Thrombolytics for stroke: The evidence”

Quick PESIT update

By now, everyone has (unfortunately) heard about the PESIT trial. Given the many commentaries in the FOAM community, we are all familiar with the many reasons that the widely quoted 1 in 6 figure probably does not apply to our patients. If you need a reminder, I summarize the paper as part of this post, or you can read a more elegant post by Rory Spiegel here. For me, the biggest issue was that PESIT never passed the sniff test. We see a ton of syncope patients. There are massive syncope databases. And nowhere have we seen massive numbers of patients returning with PE.

A research letter was just published yesterday in JAMA that gives us another take on the issue: Continue reading “Quick PESIT update”