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 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”
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)”
A handout for the EBM portion of the Hardcore EM seminar at #dasSMACC
At this year’s North York General Emergency Medicine Update, I was asked to review the most important emergency medicine literature from the past year. These are the 10 papers I decided to talk about. If you have questions or comments, please join the discussion at the bottom of the post.
Continue reading “Sweet 16 (papers of the year for NYGH EMU 2017)”
Improving your performance in high pressure situations
How well do you perform when the pressure is high? This is one of my favorite emergency medicine topics. Emergency personnel pride themselves on thriving under pressure. Doctors like to think of themselves as perfect, maybe even god-like. Combine the two, and you can imagine the ego of the average emergency physician. But underneath all that bravado, we are all human. We all experience stress, and we all respond to stress in distinctly human ways.
Continue reading “Performance Under Pressure”