I said “quiet”

Does saying “quiet” really cause chaos?

I did it again. I was at the nursing station in our resuscitation area and I commented on how quiet the night had been so far. Of course, all hell broke loose. Continue reading “I said “quiet””

Petition to retire the surviving sepsis campaign guidelines

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”

Most medical practices are not parachutes

I was invited on EMCrit to discuss my position on idarucizumab and I fear I didn’t do a great job explaining myself. I don’t want to spend more time discussing the specifics of idarucizumab, but I think the larger problem of declaring that a therapy works without study, or declaring that it would be unethical to study a therapy because we “know it works” despite a lack of randomized control trials, is worth pursuing. Continue reading “Most medical practices are not parachutes”

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.

Continue reading “Idarucizumab: Plenty of optimism, not enough science”

Sucrose: Analgesic or placebo?

Does sucrose really relieve pain in infants?

It is time for a (potentially unpopular) rant. Over the last few months, the topic of using sucrose for pain control in neonates has come up a number of times. It has been called the standard of care. It has been stated that it is unethical to run any more trials with a non-treatment arm, because we know that sucrose works.

I have a problem with that.

Continue reading “Sucrose: Analgesic or placebo?”

Tend and Befriend: Sex, gender, and performance under pressure

Anyone who has taken the time to make it through my entire post on performance under pressure knows that I have spent a lot of time reading and thinking about stress and the ways it affects us in emergency medicine. I read hundreds of articles and books when preparing my lecture and post on the topic, which is why I was particularly surprised when I was asked to comment on the literature discussing gender differences in the stress response. Despite all my reading, I hadn’t come across a single paper on the topic. Continue reading “Tend and Befriend: Sex, gender, and performance under pressure”

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?

Continue reading “Would you choose adenosine?”