A brief review of the evidence in the management of Bartholin’s abscesses
One of the very first medical myths I encountered was the packing of abscesses. It is pretty clear that packing provides no benefit in small abscesses, but significantly increases pain for our patients. (Barnes 1988; O’Malley 2009; Kessler 2012) Knowing that, I have always been confused about the management of Bartholin’s abscesses. Although exquisitely painful, these are relatively small abscesses in an area of the body with excellent vascularity and healing. It makes sense to manage them exactly like any small abscess, but I have always been taught that these abscesses absolutely required packing – and not just any packing, but the special (and sometimes hard to find) Word catheter. Was this evidence-based teaching, or just another medical myth handed down from generation to generation? Let’s look at some evidence. Continue reading “What’s the word on Word catheters?”
Busting myths to simplify resuscitation
I was asked to speak at CAEP 2018 about myths in resuscitation. Most people, by now, know that I love a good myth, but the one time that I don’t want to be debating the medical literature is when there is a critically ill patient in front of me. Those are times for action, not debate or doubt. I would care if the myth put my patient at risk, but in emergency medicine we are really good at life and death. Myths generally don’t survive if we are talking about a mortality benefit. So why would anyone want to sit through a talk about resuscitation myths? Was I about to plant seeds of doubt that would grow into critical inaction?
Continue reading “Resuscitation myths (CAEP 2018)”
The evidence for using vasopressors through a peripheral IV
You are working in a small, rural hospital staffed by one physician and one nurse. There are multiple sick patients, all of whom require your attention, but the sickest is probably the 62 year old female with pneumonia and a blood pressure of 75/40 despite 3 liters of normal saline. This is septic shock, and you need to start a vasopressor, but the hospital protocol is that norepinephrine should only be given through a central line. You just haven’t had time to get one started, and wonder if it wouldn’t be better to get the patient started on the vasopressor using their peripheral IV.
The myth: It is an absolute contraindication to administer vasopressors through a peripheral intravenous line.
Continue reading “Peripheral vasopressors: the myth and the evidence”
A monthly (ish) summary of the emergency medicine literature
Welcome to another edition of the (bi)monthly medical articles that caught my attention. As always, you can hear Casey and I ramble on about these articles and other quasi-related medical issues on the BroomDocs podcast. Continue reading “Articles of the month (May 2018)”
A brief review of the evidence for fasting in sedation
When was your last meal? Yes, I know that your leg is currently bent at about a 90 degree angle, but I must know, when did you last eat? You had some chips an hour ago? Well I’m very sorry, but you are just going to have to wait. Next time, remember that you need an empty stomach if you are going to have an emergency… Continue reading “NPO for sedation? Don’t swallow the myth”
What follows is a post that you will see on a number of websites this week explaining the petition to retract the 2018 Surviving Sepsis Campaign guidelines. You can read the guideline here. Although many of the individual recommendations seems reasonable, I think these guidelines could end up harming patients. Continue reading “Petition to retire the surviving sepsis campaign guidelines”
Hand out for the articles of the year lecture at EMU 2018
I love evidence based medicine, but I definitely understand the criticism that EBM nerds like myself can come across as very negative. Thrombolytics don’t work. BNP isn’t helpful. Stress testing is a sham. Idarucizumab? Yeah right. I think this scientific criticism is crucial, but I understand that it isn’t always fun. So when I was asked to present my favourite articles of the year at the North York General Emergency Medicine Update, I decided to stay entirely positive. I only chose papers that were potentially practice changing, but more importantly, that could have a positive impact on clinical practice. These are the papers I chose.
Continue reading “Articles of the year (EMU 2018)”