Superstitions are sort of fun. They represent a lack of scientific understanding and critical thinking that I obviously hate, but they also offer us interesting and relatively harm free insights into the many failings of human cognition. I say “quiet” a lot. I like the word. Although it occasionally upsets […]
EBM reviews
34 posts
Since publishing my 5 part series illustrating that stress tests are useless (also available as an EM Cases Journal Jam Episode and on EM:RAP), I have received a number of requests to review coronary CT angiography (CCTA). After all, stress testing is old technology. CCTA is newer and therefore obviously […]
TXA has been the darling drug of emergency medicine and critical care since the publication of the CRASH 2 trial back in 2010. CRASH 2 demonstrated a 1.5% decrease in mortality when TXA was given to trauma patients with significant bleeding. (CRASH 2 2010) These results led to the widespread […]
It’s time for another deep dive into the medical literature, this time looking at the evidence for heparin (or any anticoagulant) in the setting of STEMI and PCI. I have previously outlined the evidence that indicates that heparin shouldn’t be used (is harmful) in unstable angina and NSTEMI. However, that […]
The management of burn blisters has always produced a lot of debate. My teaching was to leave the blisters alone, as deroofing them provides no benefit but increases pain. Recently I have noticed a push to have burns debrided. Both in Canada and New Zealand, I have had plastic surgeons […]
My approach to status epilepticus is somewhat more aggressive than commonly taught algorithms. It is summarized (overly simply) as “benzo → benzo → propofol”. There have been a number of concerns raised with this strategy recently on twitter. This post outlines the reasoning (and limited evidence) behind my seizure algorithm.
Last week, I discussed the reasons that I believe that tramadol is a bad drug that shouldn’t be prescribed. This week, I will tackle a similarly bad drug: codeine. The argument is essentially the same. Tramadol may be moderately worse, because of the added SNRI effects, but the variable effects […]
I have never prescribed tramadol. I was taught that, for a variety of reasons, it’s an awful drug. In Canada, everyone seemed to agree. But then I moved to New Zealand.
