A rant about guidelines (and an opportunity to help shape the future of the ILCOR guideline process)
I hate guidelines. I shouldn’t. In theory, summaries of the medical literature that are accessible to practicing clinicians could only be good. Unfortunately, in current practice, medical guidelines are too often biased, unscientific, overreaching, or misleading.
Continue reading “I hate guidelines (but they can improve and you can help)”
A response to and discussion of a critique of evidence based medicine (EBM)
A recent podcast has caused a bit of a stir among the nerdiest of my friends. This post, in large part, is a response to that podcast, but more than that, it is a discussion of the role of science and evidence in modern medicine, so you might find it interesting even if you haven’t heard to podcast I am talking about.
Continue reading “Evidence based medicine is still the best kind of medicine”
A brief summary of the COMBAT trial looking at prehospital plasma for trauma resuscitation.
A couple weeks ago I covered the PAMPer trial, which demonstrate a potentially “unbelievable” 10% decrease in mortality by using plasma as the primary resuscitation fluid prehospital in trauma patients being transferred by air. I was somewhat skeptical (surprising I know) of the result. This is a similar study, but with different conclusions.
Continue reading “Another trial of prehospital plasma for trauma (COMBAT)”
A review of the SALT-ED trial (Self 2018) comparing 0.9% saline to balanced IV fluids in an emergency department setting
So far, this week’s discussion of IV fluid choice has focused on ICU patients in our discussion of both the SPLIT and SMART trials. I work in the emergency department and really want to know how to manage emergency department patients. To close out IV fluids week, we will look at the SALT-ED trial, which was run by the same group and at the same hospital group as the SMART trial, but focused on patients in the emergency department.
Continue reading “IV fluid choice part 3: The SALT-ED trial”
A review of the SMART trial (Semler 2018) comparing 0.9% saline to balanced crystalloid
Yesterday, I covered the SPLIT trial, comparing saline with Plasma-Lyte 148. Today we are going to look at SMART, the trial that provoked the numerous cringe-worthy popular headlines…
Continue reading “IV fluid choice part 2: The SMART trial”
A review of the SPLIT trial (Young 2015) comparing saline to Plasma-Lyte 148
“The saline used in IV bags could be killing you”, screams the New York Post. CNN seems to agree. Everyone in the world seems to know that saline is evil, but just yesterday I hung a bag of normal saline when treating a sick septic patient. Is that because I am a bad doctor? Because I haven’t read the studies? Because I don’t care? Or is this just another example of the general rule that headline news describing medical research is almost always wrong?
Those headlines were in response to two studies published in the New England Journal this year: SMART and SALT-ED. I will get to those papers in the next 2 days, but I think we should start with what was previously the largest, and still is the best trial available comparing saline to a balance IV solution. Welcome to IV fluids week…
Continue reading “IV fluid choice part 1: The SPLIT trial”
The PAMPer study (Sperry 2018) – Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock
Fluid resuscitation in trauma: a topic about which there are almost certainly more strong opinions than there are strong studies. We have moved away from crystalloid and towards using blood products, which makes some sense, given that is what the patient is losing. One question that remains is the role of plasma in resuscitating these patients, which leads us to this RCT.
Continue reading “Prehospital plasma in trauma (PAMPer)”