Embracing Science: #dasSMACC Hardcore EM handout

A handout for the EBM portion of the Hardcore EM seminar at #dasSMACC

Continue reading “Embracing Science: #dasSMACC Hardcore EM handout”

Articles of the month (May 2017)

I took another month off, but the blog and accompanying podcast are back with what I think is an interesting collection of articles… Continue reading “Articles of the month (May 2017)”

Thrombolytics for stroke: The evidence

A summary of the evidence for (or against) thrombolytics for stroke

Thrombolytics for stroke: undoubtedly the biggest controversy in emergency medicine. Also, the topic of this week’s Emergency Medicine Cases Journal Jam podcast. Rory Spiegel, Anton Helman, and I take a deep dive into the evidence. Why would we do this? No, it isn’t just that we have too much time on our hands. The journal jam podcast exists because we truly believe it is important to understand why we do what we do, both to ensure we are always providing the best care for our patients, but also so that we can explain that care to our patients. The evidence for (or against) thrombolytics is important precisely because the topic is so controversial. You will hear arguments on both sides. So will your patients. It is only through a familiarity with the studies, their strengths, and their weaknesses, that you will be able to decide for yourself what the evidence really shows and guide your patients to the best decision for their circumstances.

What follows are the notes I made while preparing for the podcast. First, I review the major randomized controlled trials looking at thrombolytics for stroke. That is followed by a discussion of the things I think are important to consider when trying to interpret this data. (Many folks might want to skip straight to this discussion section.) Continue reading “Thrombolytics for stroke: The evidence”

Quick PESIT update

By now, everyone has (unfortunately) heard about the PESIT trial. Given the many commentaries in the FOAM community, we are all familiar with the many reasons that the widely quoted 1 in 6 figure probably does not apply to our patients. If you need a reminder, I summarize the paper as part of this post, or you can read a more elegant post by Rory Spiegel here. For me, the biggest issue was that PESIT never passed the sniff test. We see a ton of syncope patients. There are massive syncope databases. And nowhere have we seen massive numbers of patients returning with PE.

A research letter was just published yesterday in JAMA that gives us another take on the issue: Continue reading “Quick PESIT update”

Ultrasound for pediatric forearm fractures (SGEM HOP)

The most recent episode of the SGEM hot of the press series came out today. The article we reviewed was looking at the utility of point of care ultrasound in pediatric forearm fractures:

Poonai N, Myslik F, Joubert G et al. Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes. Acad Emerg Med. 2017. Continue reading “Ultrasound for pediatric forearm fractures (SGEM HOP)”

Sweet 16 (papers of the year for NYGH EMU 2017)

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)”

The conversation that extended my career

We all mistakes. It’s better to talk about them.

My heart is pounding. My stomach is in a knot. I can’t think straight.

I made a mistake. Continue reading “The conversation that extended my career”