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 […]
EBM reviews
33 posts
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.
Whenever you order a test, it is essential to know what you are going to do with the results. Tests, by themselves, cannot improve patient outcomes. Benefit can only occur if the test results in appropriate patients receiving a proven intervention.