Idarucizumab: Plenty of optimism, not enough science

A critique of the current science supporting idarucizumab

Optimism is essential. Few things are as powerful as hope for the future. When facing an onslaught of critically ill patients, optimism allows emergency physicians to persist. Optimism, however, can cloud also cloud our judgement; allow us to focus only on the good, not the bad. As physicians, we cannot afford optimism blindness. We need to be objective. We need to be scientists.

This month I was distressed to hear overly-optimistic, unscientific statements about idarucizumab on two of my favourite emergency medicine education programs: EM:RAP and EM Cases. I have incredible respect for these sources. EM:RAP has been irreplaceable in my emergency medicine education. On EM Cases, the statements were made by Dr. Walter Himmel, who is one of the smartest individuals I have ever had the opportunity to meet. But in this instance, I think that they were both wrong.

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Evidence Based Medicine is Easy

A simplified guide to approaching the medical literature

Evidence based medicine is easy.

I know that evidence based medicine scares people. That stats seem complicated. Papers are often full of obtuse language. People are constantly debating small details at journal clubs, which can leave many physicians feeling inadequate.

But I can assure you, evidence based medicine is easy. If I can do it, anyone can. The only difficult part is getting into the habit of actually picking up a paper and starting to read.

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Does contrast cause kidney injury? The evidence

A look at the evidence around post contrast acute kidney injury (or “contrast induced nephropathy”)

It’s time for another Emergency Medicine Cases Journal Jam, and we chose to tackle the concept of “contrast induced nephropathy” this time around. For this review, we focused on the risk of acute kidney injury following intravenous contrast for CT scans, because that is what we are really concerned about in the emergency department. For a variety of reasons, including higher contrast loads, higher risk patients, and procedure induced micro-emboli, the risk of kidney injury is significantly higher when using intra-arterial contrast for procedures such as cardiac catheterization. What follows are the notes I made in preparation for the podcast.

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Article of the month (November 2017)

There are a lot of recurrent themes in this month’s edition (which has clearly shifted from being a monthly to a bimonthly publication). Podcast over on BroomeDocs.

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Articles of the month (September 2017)

A monthly summary of the emergency medicine literature

Back with another edition of the “articles of the every month or so”. I love reading these papers and sharing them with everyone, but I’ve decided I should have at least a modicum of a pathetic social life as well, so every 2 months is probably the best I can do. Even then, I’m not sure they are worth what you are paying for them….

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Would you choose adenosine?

Comparing adenosine to calcium channel blockers in the management of SVT

Hi sir. My name is Dr. Morgenstern. That racing feeling in your chest… it’s something we call SVT. That just means that you heart is going too fast. I’m going to get it slowed down for you. All that silly stuff we just did – getting you to blow in a syringe and raising your legs above your head – that sometimes works, but honestly, I have never seen it work myself. It’s time to stop asking you to “bear down” and move on to using medications to slow your heart down. Right now, your blood pressure is fine and you have no other problems, so we have a few options.

Option number one is a medication that works about 90% of the time, but it causes a horrible feeling when it is given. Some people describe it as chest pain. Others say is feels like they are going to die. Most people tell me it is the worst thing they have ever experienced.

Option number two is a medication that works closer to 100% of the time and doesn’t cause any pain at all.

Which would you prefer?

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Articles of the month (July 2017)

A monthly summary of the emergency medicine literature

Welcome back to another edition of the articles of the month. I am considering changing the format of my article reviews going forward. Because multiple articles are grouped together in a single post, I frequently have a hard time finding articles I have reviewed when I am looking for them. I might start posting each article as its own blog post, with 8-10 posts over the course of a month. I’d love to hear what people think of that idea – whether it would be better or worse for your reading habits. Either way, Casey and I will still discuss the best articles each month on the Broome Docs podcast. Continue reading “Articles of the month (July 2017)”