Bias in medical research

A glossary of common research biases

A bias in evidence based medicine is any factor that leads to conclusions that are systematically different from the truth.  Continue reading “Bias in medical research”

Bougie is better (Driver 2018)

Should we use a bougie routinely for our first attempt at intubation?

I love the bougie as a rescue technique for difficult airways, but many people use the bougie routinely on their first attempt. I discussed some previous retrospective data from this group in the March 2018 Articles of the Month. Now, they provide us with the best evidence to date, in the form of a RCT. Continue reading “Bougie is better (Driver 2018)”

TXA in ICH (TICH-2)

Summary of a RCT looking at tranexamic acid in intracerebral hemorrhage

This is a new post format for First10EM. When it comes to evidence based medicine, I have kept to 2 general formats: the deep dive (aka tPa for stroke) and the semi-monthly “articles of the month” which covers any paper I have read and found interesting. The problem with the articles of the month format is that it makes it very difficult to find comments on older papers. If you wanted to find my commentary on the WOMAN trial, a search would just lead you to a post titled “articles of the month May 2017”, which isn’t super helpful. Therefore, I am going to start writing more posts that cover individual papers. This means that they will be shorter reads, and that you will see First10EM pop up in your feed a little more often. I hope this this is helpful rather than annoying. Either way, I am always looking for feedback. (The podcast every month or two with Casey Parker will continue.)

Our first paper looks at the silver bullet of modern emergency medicine – a drug so beloved that I am surprised it is even considered ethical to study it anymore – tranexamic acid, and its role in nontraumatic intracerebral hemorrhage.

Continue reading “TXA in ICH (TICH-2)”

What’s the word on Word catheters?

A brief review of the evidence in the management of Bartholin’s abscesses

One of the very first medical myths I encountered was the packing of abscesses. It is pretty clear that packing provides no benefit in small abscesses, but significantly increases pain for our patients. (Barnes 1988; O’Malley 2009; Kessler 2012) Knowing that, I have always been confused about the management of Bartholin’s abscesses. Although exquisitely painful, these are relatively small abscesses in an area of the body with excellent vascularity and healing. It makes sense to manage them exactly like any small abscess, but I have always been taught that these abscesses absolutely required packing – and not just any packing, but the special (and sometimes hard to find) Word catheter. Was this evidence-based teaching, or just another medical myth handed down from generation to generation? Let’s look at some evidence. Continue reading “What’s the word on Word catheters?”

Resuscitation myths (CAEP 2018)

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)”

Peripheral vasopressors: the myth and the evidence

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”

Articles of the month (May 2018)

A monthly (ish) summary of the emergency medicine literature

Welcome to another edition of the (bi)monthly medical articles that caught my attention. As always, you can hear Casey and I ramble on about these articles and other quasi-related medical issues on the BroomDocs podcast. Continue reading “Articles of the month (May 2018)”