Research Roundup – December 2025

A bunch of interesting fresh off the press medical articles, and that one bonus paper that snuck in for some reason. 

Stop using steroids to pretreat contrast allergies!! (The radiologists said so)

Byrne A, Macdonald DB, Kirkpatrick IDC, Pham M, Green CR, Copaescu AM, McInnes MDF, Ling L, Ellis A, Costa AF. CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity. Can Assoc Radiol J. 2025 Aug;76(3):400-416. doi: 10.1177/08465371241311253. Epub 2025 Jan 11. PMID: 39797723

Stop with the stupid allergy pretreatment regimens for reported contrast allergy! That is basically a direct quote from the most recent 2025 Canadian Association of Radiologists guideline. Okay, the exact quote is, “In patients with a history of hypersensitivity reaction to LOCM iodinated contrast media, premedication with steroids is not supported by high quality research. What evidence exists is methodologically flawed and pertains to HOCM. Due to lack of efficacy and likely harms associated with steroid pretreatment prophylaxis, the working group recommends against routine use of steroids in high-risk patients. This practice should be discontinued.” I will repeat that, for those in the back: the practice should be discontinued! Now the only question is whether anyone will listen to these guidelines. They discuss some of the background literature. There is really no evidence that steroids change anything except for minor rashes after contrast, but they are optimistic, and suggest that there might be a number needed to treat of 56,900 to prevent one death and an NNT of 569 to prevent one severe reaction. That might be fine if these steroid protocols were harm free, but in addition to the massive increases in length of stay (25 hours on average), steroids also have other side effects, such as infection. Given the NNT of 56,900, they estimate that in order to save on life from an allergic reaction you will end up causing 551 hospital acquired infections and 32 infection related deaths. We do this a lot in medicine. We become so myopic on a topic (in this case, trying to prevent allergic reactions at all cost), that we lose track of the bigger picture. So, the time to change is now. You can give an antihistamine to try to prevent mild allergic reactions, but you should not be giving steroids as part of a prophylactic regimen for IV contrast. This is the section of the paper that needs to be shared far and wide. The best evidence, as agreed on by the radiologists and allergists, is that steroid pretreatment protocols are killing patients. Harms outweigh benefits. This needs to stop now.

There are some other useful recommendations in here. The most important thing that you can do is actually something I have never seen done at any hospital I have ever worked at. Patients need to have the specific contrast agents that they were allergic to documented, and “for patients with a history of a mild, moderate, or severe hypersensitivity reaction to ICM or GBCA, switching to a chemically different contrast agent is the single best protective measure to avoid a breakthrough reaction.” The problem, of course, is that most hospitals only stock a single agent, and so instead try to offload the responsibility on to the emergency clinician by enforcing ridiculously prolonged pretreatment regimens. The radiologists’ own guidelines tell us that it is time to stop! (But will they listen?)

As an added bonus, if you are at one of the hospitals that has fallen into the bizarre myth that patients need to be NPO for contrast scans, these guidelines are also very clear that we should stop that practice. “It is recommended that patients not be instructed to fast prior to receiving intravascular contrast media, unless required for the specific imaging examination (eg, CT or MR enterography).”

A longer write up can be found here.

Are we laying or lying here?

Alexandrov AW, Shearin AJ, Mandava P, Torrealba-Acosta G, Elangovan C, Krishnaiah B, Nearing K, Robinson E, Guthrie-Chu C, Holzmann M, Fill B, Trivedi DR, Richardson A, Middleton S, Brewer BB, Liebeskind DS, Goyal N, Grotta JC, Alexandrov AV; ZODIAC Investigators. Optimal Head-of-Bed Positioning Before Thrombectomy in Large Vessel Occlusion Stroke: A Randomized Clinical Trial. JAMA Neurol. 2025 Sep 1;82(9):905-914. doi: 10.1001/jamaneurol.2025.2253. PMID: 40465238

I saw this paper when it was originally published, and although I thought the topic and design were interesting, my initial instinct was that this was probably silly, and with a very narrow scope, and so I deleted it without a write up. Then Scott Weingart called me out, declaring it a practice changer, and telling me to “come at him” if I disagreed with that language, so I redownloaded the paper for a second look. The basic idea was to look at whether head of bed positioning might impact outcomes in stroke patients, with the assumption that removing gravity could increase flow through a narrow artery. They randomized patients with CT angio proven large vessel occlusions who were candidates for thrombectomy to either 0° or 30° head positioning. One reason I had originally skipped this paper is because I thought the inclusion criteria included a perfusion scan, which is not done anywhere I work, but an ASPECTS score or 6 or more also counted as representing a viable penumbra. (They also didn’t include any transferred patients, which severely limits generalizability to the practice settings the vast majority of us work in.) They were supposed to include 182 patients, but stopped the trial early after 92. The numbers were pretty astonishing. One patient with 0° head positioning and 20 patients with 30° head positioning experienced worsening on the NIHSS of 4 points or more prior to thrombectomy (their primary outcome). All cause mortality was also dramatically different, at 4.4% vs 21.7% (p=0.03). I think this is a brilliant little study, asking an interesting question, and Scott could be right that this is “practice changing” for the short term, but I think there are a lot of reasons to believe that the results will end up being incorrect. I think there is an interesting debate to be had about the prior plausibility of this intervention. It is a simple intervention, and gravity is a real thing, although I have never really believed bed positioning truly impacts clinical outcomes. (I have never put hypotensive patients in Trendelenburg.) Perhaps it is my skeptical priors, but a 17% absolute difference in all cause mortality is unheard of. Like, I think it is literally unbelievable. It would be wonderful if it were true, but we basically have no interventions that are this effective, so to me this feels more like a red flag of bias rather than proof of a miracle cure. Remember, this is an unblinded trial that was stopped early. The fundamental problem with the trial is that they made their primary outcome neurologic deterioration in the short time period prior to thrombectomy. That is not a patient oriented outcome. We don’t want to see our patients deteriorate, but if we are taking the clot out anyway, the clinical exam in that time period is much less important than long term outcomes. It is the equivalent of a TIA. What matters is long term outcomes. Unfortunately, probably because they stopped the trial early, all of the long term outcomes in this trial are statistically negative. The point estimates look better, but given that this is an open label trial, and therefore prone to bias, I think the lack of difference in the patient oriented long term outcomes is important. With those limitations, this has to be labelled unproven. This is definitely not “standard of care”. My hope is that these results are real, because they are miraculous, but my bet is that future trials will turn out to be negative. That being said, Scott might be right that this is, at least for the time being, “practice changing”. The outcomes are dramatic, and the harms are pretty limited. There is some risk that people extrapolate this to the wrong patients. Most stroke patients need to have the head of their bed up to reduce aspiration risk. However, for the very rare EVT patient, having the head of the bed flat for 60 minutes while you transfer for EVT seems very low risk, and so it is reasonable to change practice based on low quality evidence.

Bottom line: This open label RCT of patients going to thrombectomy showed dramatic short term improvements from lowering the head of the bed to 0°. Long term neurologic outcomes were not statistically significant, and there are multiple sources of bias. It is reasonable to change practice for the short term, but this study needs larger and more robust follow-up studies before this can be considered a proven therapy. 

You took my breath away

Strayer RJ, Oliver M, Chen A, Gerges L, Caputo ND. The Impact of Suctioning on Oxygenation During Rapid Sequence Intubation in the Emergency Department: A Multi-Center Pilot Randomized Controlled Trial. J Emerg Med. 2025 Sep;76:88-94. doi: 10.1016/j.jemermed.2025.04.016. Epub 2025 May 22. PMID: 40533376

This is a brilliant little study by friend Reuben Strayer. The SALAD method, developed by Jim Ducanto, is a very effective method of dealing with soiled airways, in which you lead with suction (inserting it before your video laryngoscope), preventing the scope from becoming soiled, and leave the suction in the pharynx throughout the entire procedure. However, especially given the popularity of apneic oxygenation, there has been some question of whether constant airway suction might affect oxygenation. This is a pilot study from 3 hospitals, in which patients undergoing RSI in the emergency department were randomized to either constant suction or suction only as needed. They excluded patients with known or predicted heavily soiled airway (significant blood or emesis in mouth), so this isn’t a study of the value of the suction technique, just an assessment of impacts on oxygenation if the technique is used routinely rather than just when needed. They randomized a total of 76 patients, and there were no differences at all. Oxygen saturations remained the same from preoxygenation to endotracheal tube confirmation in both groups. Unless I am blind, I don’t seen any mention of first pass success here, but these were relatively quick attempts, taking 70-80 seconds until confirmation of ETT. I wouldn’t expect suction to make a huge difference, and I definitely wouldn’t expect to see a difference in quick intubations in patients with good baseline oxygenation. Combined with the small size of the study, I don’t think we can say definitively that this is a safe practice. It is easy to imagine a scenario where the patient starts with more tenuous oxygenation, and the intubation takes somewhat longer, and perhaps the suction would lead to more rapid desaturation. Personally, I don’t know anyone using the SALAD technique routinely. I have only seen it taught and used in patients with soiled airways, or at high risk of a soiled airway. In patients with a soiled airway, the risk/benefit analysis is pretty straightforward: ability to pass the tube trumps any theoretical risk of sucking oxygen out of the airway. However, I don’t need this technique in the vast majority of my patients. I don’t think this study does anything to suggest it should be routine.

Bottom line: It is so nice to see RCTs done to ask simple, easy to answer, but important questions. I love covering papers like this. To me, it seems pretty obvious that suction is not going to remove a patient’s access to oxygen, but it is nice to see that presumption confirmed in an RCT, even if it doesn’t perfectly apply to all patients.

Most controversial paper of the month? ANDROMEDA-SHOCK-2

ANDROMEDA-SHOCK-2 Investigators. Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial. JAMA. 2025 Oct 29:e2520402. doi: 10.1001/jama.2025.20402. Epub ahead of print. PMID: 41159835

I will be interested to see how this paper is eventually talked about. It got some early hype, especially from EMCrit, but reading through the methodology myself, I am far less excited. It is a big, multicenter RCT looking at adult patients with septic shock, and comparing standard care to a 6 hour bundle of care they refer to as “personalized hemodynamic resuscitation protocol targeting capillary refill time”. They enrolled 1501 patients, and they were able to find a statistical difference in their composite primary outcome. However, there was no difference at all in mortality (26.5% vs 26.6%), and so the difference seems to be driven by a composite within their primary composite: “duration of vital support”. Even within this second composite, there doesn’t seem to be a difference in mechanical ventilation or length of vasopressor use, so the entire change is about 1 day’s worth of renal replacement therapy. We could debate how important that outcome is as compared to the cost and opportunity cost of implementing this intensive algorithm, but I think that might be missing the point. Treatment decisions like renal replacement therapy are very subjective, and this is a non-blinded trial, and therefore this outcome is at high risk for bias. At the end of the day, what I see is a small change in a questionably important secondary outcome in an unblinded trial. Despite the hype, I would not call this one practice changing, and I can’t see myself using this specific algorithm in my practice. (Of course, this is primarily an ICU study, so if the intensivists want to get these patients up to the ICU within the first couple hours to start this intervention, I am more than happy to share the work load.)

Bottom line: This paper will be widely discussed, and it is an important paper asking an interesting question, but despite being statistically positive, I think the composite outcome and unblinded nature of the trial mean that this is not for everyday use at this time. 

A longer, more detailed write up of this paper can be found here. 

No value from art lines?

Muller G, Contou D, Ehrmann S, Martin M, Andreu P, Kamel T, Boissier F, Azais MA, Monnier A, Vimeux S, Chenal A, Nay MA, Salmon Gandonnière C, Lascarrou JB, Roudaut JB, Plantefève G, Giraudeau B, Lakhal K, Tavernier E, Boulain T; CRICS-TRIGGERSEP F-CRIN Network and the EVERDAC Trial Group.. Deferring Arterial Catheterization in Critically Ill Patients with Shock. N Engl J Med. 2025 Oct 29. doi: 10.1056/NEJMoa2502136. Epub ahead of print. PMID: 41159885

This is an ICU study looking at arterial line use that probably won’t be applicable to most people reading. (The potential value of an arterial line by the time a patient has been stabilized and sent to the ICU is very different from the potential value in the initial highly dynamic resuscitation.) It is a multicenter open label non-inferiority trial comparing arterial line to noninvasive brachial cuff in 1010 patients with hypotension and signs of tissue hypoperfusion admitted to the ICU within 24 hours before trial enrollment. They removed arterial lines if they had been put in prior to enrollment, and had relatively strict criteria for allowing an arterial line to be placed, which were mostly followed. Arterial lines were placed in 98% of the art line group and 15% of the conservative management group. Their primary outcome was all-cause mortality, and occurred in 34.3% of the conservative group and 36.9% of the invasive group, allowing for a conclusion of non-inferiority. As I have said before, I think non-inferiority trials are dramatically over-used, and can lead to a lot of confusion. I am not sure what we were supposed to do if the conservative group actually looked 1% worse, but was still within the non-inferiority margin, but luckily in this case the invasive group looks worse. There were a few secondary outcomes that favoured each group. There were a few more infections and local bleeding complications with art lines. On the other hand, there were a lot more one time arterial blood draws in the conservative group, and they also had more persistent pain related to the blood pressure cuff. I imagine some people will have strong opinions in both directions. There is not a lot to separate the two groups here, which means the non-invasive approach should probably be used more often, but there is also nothing here that says arterial lines should be banned. There were some harms associated with the noninvasive group. Clinicians should be allowed to use judgement, and that judgement should probably be focused on the potential need for arterial blood sampling (which should be rare) and scenarios in which noninvasive monitoring may be untrustworthy (essentially highlighted in the exclusion criteria here.)

Bottom line: This is an ICU paper, and its open label design adds some risk of bias, but the result that routine invasive blood pressure monitoring in stable ICU patients is not needed is probably correct.

Don’t be a fool, wrap your tool

Rippey J, Morris F, Moseley C, Sowerby J, Chiverton L, Mason J. Post-Procedure Perforation Rates in Ultrasound Transducer Covers Used for Ultrasound-Guided Percutaneous Procedures in Emergency Medicine: A Comparison Between Polyurethane Covers and Polyethylene Covers. Australas J Ultrasound Med. 2025 Sep 25;28(4):e70025. doi: 10.1002/ajum.70025. PMID: 41017784

My opinion that the lead author of this paper is one of the best ultrasound educators in the world might be slightly biased by the fact he is just a wonderful bloke who let me spend a beautiful vacation at his cabin in rural Western Australia. I don’t think any of those facts will be pertinent to the science or the critical appraisal. It is a small and somewhat niche topic, but I like small studies, because they often address interesting questions that can be answered within a single study. This is a prospective observational study that serendipitously turned into a sort of natural experiment because the department changed the type of ultrasound probe cover being stocked from polyurethane to polyethylene part way through the study period. After any procedure that involved a needle breaking skin under ultrasound guidance, they asked the clinicians to place the cover in a ziplock bag rather than disposing of it. They then tested the probe covers in the simplest way possible: filling them with tap water and looking for leaks. (Perhaps the biggest critique of this paper might be that it could be possible to damage a cover in a way that would allow bacteria through without allowing a visible water leak.) They found a perforation rate of 2.4% for polyurethane bags and 15.1% for polyethylene. Of course, not all of these were a surprise. About 10% of the time, the operator was aware that they had damaged the cover, but that obviously means that 90% of the time the operator was not aware of the leak. The one real bias to consider: they switched to a different type of probe cover that they were not familiar with. If the new probe cover was a different size, or needed to be rolled over the probe in a different way, there might have been more user error during the transition. This might not be an inherent problem with the material itself. I generally don’t like wash out periods, but in this study it might have been good to see a gap of a few months while the clinicians got used to the new device before assessing perforation rates. Personally, I am not sure how much clinical value this adds, because I have never really trusted these flimsy plastic bags. I clean the probe before I start, and it is not like the probe is making direct contact with the needle or puncture site most of the time. I wonder what the results would look like if you compared infection rates or real clinical outcomes with and without these covers. (Obviously no one is ever going to do that study. I am not really recommending it. I never touch patients without gloves, and I have seen how these ultrasound probes are cared for in the average department.)

I tried to cheat and use AI to see if other studies have looked at this question, and AI also believes polyethylene has a higher perforation rate, but it returns these exact numbers (15.1% vs 2.4%, so although the model I used didn’t cite its source, it seem like this might be the one paper on the topic.)

This study does highlight a massive cultural difference in the practice of medicine, and a major frustration for me when I have worked in Australia and New Zealand. 70% of the procedures here were ultrasound guided IVs. That number rings true based on my experience in Australasia, but would be unheard of in most Canadian emergency departments. I have only performed 1 or 2 ultrasound guided IVs in the course of 15 years of practice in Canada. IVs are a nursing procedure in Canada, and the skill level is unbelievably high. Despite working with a population with a high rate of IV drug use, months will pass without a nurse approaching me about difficulty getting an IV. Conversely, in New Zealand, I was approached 5 to 10 times every shift, and I noticed that the registrars were using the ultrasound machine constantly for this procedure. My sense is that as soon as you have the ultrasound guided approach as a crutch, you are going to use it, but when it isn’t there as an easy get out of jail free card, skill level increases over time, and these IVs all miraculously get started without the fancy technology. The development of that skill probably does mean that some patients get more IV attempts. However, once the skill is developed, it frees up a ton of time for doctors to be assessing patients rather than performing procedures that are easily delegated. (Obviously the best of all worlds is probably just training nurses in the use of ultrasound for when it is needed.)

Bottom line: This is not a methodologically rigorous study, and this is not a topic I lose a lot of sleep over, but if you are stocking your department, you might want to consider whether the cheap ultrasound probe covers are actually doing their job. If they are failing in 1 in ever 6 uses, is it even worth using them at all?

Combining bad data leaves you with bad data

Dubucs X, Gingras V, Boucher V, Carmichael PH, Ruel M, De Wit K, Grewal K, Mercier É, Blanchard PG, Benhamed A, Charpentier S, Émond M. Risk Factors for Traumatic Intracranial Hemorrhage in Older Adults Sustaining a Head Injury in Ground-Level Falls: A Systematic Review and Meta-analysis. Ann Emerg Med. 2025 Jul 22:S0196-0644(25)00313-0. doi: 10.1016/j.annemergmed.2025.05.021. Epub ahead of print. PMID: 40699169

I probably wouldn’t have picked this paper. In fact, I specifically skipped it, because I thought the abstract made it pretty clear that the data was garbage. (When anticoagulants are not a risk factor for head bleeds, your data is clearly biased. When I see such a glaring issue with data, I generally think it is better off ignored). However, the paper was sent to me multiple times, so I guess it has captured people’s attention. I will therefore give it a few more sentences. I find systematic reviews hard to critically appraise, because excellent review methodology can easily be undone by garbage data. To adequately understand the systematic review, I often find myself reading all of the underlying research, which sort of undermines the entire value of the review.  For what it’s worth, this review has excellent methodology. They include 17 observational studies (only 7 of which were prospective) encompassing 22,520 elderly patients with ground level falls. The overall prevalence of traumatic intracranial hemorrhage was 6.8%. Only 8% of patients with ICH had an urgent neurosurgical procedure. Outside of having an open or depressed skull fracture, signs of a basilar skull fracture, focal neurologic signs, or a depressed GCS, most of the odds ratios were underwhelming. However, I wouldn’t spend much time looking at these numbers. This dataset is clearly biased. The authors miss the point entirely when they say, “these results suggested that anticoagulants may not be associated with an increased risk of traumatic ICH in this population.” That is not at all what this data says. The fact that anticoagulants appear to be protective simply tells you that the data is biased. This is not a dataset of all elderly patients with ground level falls. It is a data set of elderly patients with ground level falls in whom the physician was worried enough to order a CT. Anticoagulants appear protective because essentially 100% of patients on anticoagulants have CTs ordered. The ultimate problem is that we have no idea why these CTs were ordered, especially when the majority of this data is retrospective. We therefore cannot know which of these other factors are biased in similar ways. All we can know is that the dataset is hopelessly biased. Please do not make clinical decisions using this data. 

Bottom line: Combining data in systematic reviews does not magically repair the biases in the original studies. 

Uncertainty in medical training

Ilgen JS, Dhaliwal G. Educational Strategies to Prepare Trainees for Clinical Uncertainty. N Engl J Med. 2025 Oct 23;393(16):1624-1632. doi: 10.1056/NEJMra2408797. PMID: 41124633

“Uncertainty is ubiquitous in medical practice. If there was no uncertainty, society would not need physicians to render judgments.”

It is possible that this article just caught my eye because it popped into my feed the same week that I was giving a talk entitled “Embracing Uncertainty”. That being said, I think that a lot can be gained from consciously addressing the uncertainty of day to day medical practice, and this article runs through a few of the ways that you can incorporate this uncertainty into your teaching. In my mind, the biggest mistake we make when we teach is behaving as if uncertainty can be resolved. We use multiple choice tests that have a single correct answer, which do nothing to prepare students for a world where black and white answers don’t exist. We present cases that have neat stories, instead of the messy confusing cases that students will encounter in the real world. What do you do when the knee tap shows crystals but also has a high white count? What do you do when the post arrest patient has a CT demonstrating pulmonary emboli, but there is also a type B dissection? How do you manage the STEMI patient that fainted, fell down the stairs, and has an epidural hematoma? These are real world cases that are never discussed, at least in the medical education that I have been exposed to.

Can emergency medicine be saved?

Atkinson P, Lang E. Can emergency medicine be saved? CJEM. 2025 Oct;27(10):760-763. doi: 10.1007/s43678-025-01034-w. Epub 2025 Oct 18. PMID: 41108498

I expect the responses to this article will be strong, probably both in support and in critique. It certainly touches a nerve. They point out the burnout rates in emergency medicine are the highest of any speciality, and the result is that people are leaving practice, which only increases the burden on those left behind. (In the places that I work, this is more evident in the exodus of emergency nursing, but can certainly also be seen among physicians.) They tell us that “emergency medicine is not just another specialty; it is a core pillar of the societal safety net. When someone experiences a medical emergency, they know a trained team will be there: to receive them without delay, to diagnose, stabilize, and initiate treatment, and to facilitate access to the next stage of care. If that pillar weakens, patients lose not just a service, but the guarantee of immediate, professional, life-saving care on which modern society depends.” Although it is not really the point of their essay, it made me reflect on my department as the pillar of my own community, which my family or I may need to use. The emergency department has always been chaotic, but as I age, and picture my family, myself, or my child getting sick, I spend more time reflecting on the abysmal environments patients face in most hospitals, and especially in the emergency department. Despite taking massive pride in my job, if I were to be sick, I wouldn’t want to spend time in any of the departments I work in (even if I could avoid a hallway bed because of my ‘VIP physicians status’). That is just incredibly sad. We have so much work to do. One of the issues these authors identify is the significant scope creep that has occurred in emergency medicine. Every year that passes, we are expected to do more. When in the past we might have just covered for a speciality overnight to let them get some sleep, we are now faced with clinic closures or extremely long wait lists, which means that we have to assume full responsibility for the patient’s entire management plan, no matter which specialty used to be responsible. We don’t just perform medical tasks, but are also asked to act as social workers, physiotherapists, counselors, clerical staff, and nurses, depending on which service is under-staffed on that given day. “The paradox is that the more comprehensive we try to be, the less capacity we have to deliver on our true mandate: timely recognition and stabilization of acute, life-threatening illness and injury.” They think that the only solution is to scale back. “If we do not scale back what we are trying to do, emergency medicine as a specialty may not survive. That does not mean narrowing our skills.. Nor does it mean narrowing our compassion… The first step is to reaffirm our primary mission: rapid assessment and stabilization of emergency presentations in the first hour or two.” Of course, we can’t do this alone. “Other specialties must re-engage in urgent and unscheduled care, providing real seven days per week access for their patients. Hospitals must be accountable for inpatient flow, not offload the consequences into the ED. Community systems must provide accessible primary care and urgent outpatient referral pathways. Without this redistribution, emergency medicine will continue to carry an impossible load, with predictable consequences for both patients and staff.” I expect my thoughts on this will evolve as I sit with it, and I may follow up with a longer article of my own. I am really interested to hear everyone else’s thoughts, whether you just need to vent, or, perhaps, you have some creative ideas to reengaging other specialties to remove some of emergency medicine’s “dumping ground” status. 

If we can’t save emergency medicine, maybe we can get jobs transporting Rhinos?

Radcliffe RW, Jago M, Morkel PV, Morkel E, du Preez P, Beytell P, Kotting B, Manuel B, du Preez JH, Miller MA, Felippe J, Parry SA, Gleed RD. THE PULMONARY AND METABOLIC EFFECTS OF SUSPENSION BY THE FEET COMPARED WITH LATERAL RECUMBENCY IN IMMOBILIZED BLACK RHINOCEROSES (DICEROS BICORNIS) CAPTURED BY AERIAL DARTING. J Wildl Dis. 2021 Apr 1;57(2):357-367. doi: 10.7589/2019-08-202. PMID: 33822147

What search term did I enter to find this paper? Irrelevant, because look at figure 1:

Rhinos often have to be moved to protect them from poaching, and because of the terrain, helicopters are frequently employed. But what are the respiratory effects of suspending a rhinoceros upside down during flight, especially considering the very large doses of opioids that must be used to convince a rhinoceros to allow you to put them through this indignity? That is what this study asked, by measuring arterial blood gases in 39 rhinoceroses both in the lateral recumbent and ‘suspended by feet’ positions. Unfortunately, external validity is extremely limited by the fact that they were suspended by a crane just off the ground, rather than being flown at altitude by a helicopter. I would have loved to see some pictures of arterial blood draws being performed on a rhino mid-flight 100 feet below a helicopter. I don’t know a ton about rhinoceros physiology, but the fact that we are comparing an oxygen saturation of 63% in lateral recumbency to 71% in the suspended group makes me worried that in protecting rhinos from poaching we might be causing some significant hypoxic brain injury with our drug doses. (I don’t know if there is a mini-mental exam equivalent for rhinos?) Perhaps the fact that gravity is sending more blood to the brain partially compensates for the severe hypoxia? (Remember that stroke paper? Perhaps our stroke patients would fare even better suspended by their feet underneath a helicopter?)

Why do I include such a paper? Is there any value to you? Well, I supposed you could use this paper to review some basic pulmonary physiology, if you so pleased. More likely, it should just provoke feelings of compassion for whatever bizarre pathology I have that results in me finding the rhinoceros literature section of Pubmed.

Cheesy joke of the month

What does the nurse think when she finds a rectal thermometer in her front pocket?

“Damn, some asshole has my pen.”