I hate guidelines (but they can improve and you can help)

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)”

Idarucizumab: Plenty of optimism, not enough science

A critique of the current science supporting idarucizumab

Optimism is essential. Few things are as powerful as hope for the future. When facing an onslaught of critically ill patients, optimism allows emergency physicians to persist. Optimism, however, can cloud also cloud our judgement; allow us to focus only on the good, not the bad. As physicians, we cannot afford optimism blindness. We need to be objective. We need to be scientists.

This month I was distressed to hear overly-optimistic, unscientific statements about idarucizumab on two of my favourite emergency medicine education programs: EM:RAP and EM Cases. I have incredible respect for these sources. EM:RAP has been irreplaceable in my emergency medicine education. On EM Cases, the statements were made by Dr. Walter Himmel, who is one of the smartest individuals I have ever had the opportunity to meet. But in this instance, I think that they were both wrong.

Continue reading “Idarucizumab: Plenty of optimism, not enough science”

Articles of the month (November 2016)

It’s that time again. Sure, there may be a lot to do during the month of December, but what better way to procrastinate than to grab a mug of hot chocolate, sit down in front of the fire, and read about some evidence based medicine….

(If that doesn’t sound appealing, you could toss in some earphones while you do your holiday shopping and listen to me and Casey ramble about these papers in the audio version on the BroomeDocs podcast.) Continue reading “Articles of the month (November 2016)”

EBM Lecture Handout: Good evidence based medicine resources

This is a summary of some of the key resources that I use to help me keep up with the most current medical literature. Continue reading “EBM Lecture Handout: Good evidence based medicine resources”

EBM Lecture Handout #1: PPIs for GI Bleeds

Should we be starting PPIs on undifferentiated upper GI bleed patients in the emergency department prior to endoscopy?

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EBM Lecture Handout #2: Topical Anaesthetics fo Corneal Abrasions

A summary of the evidence supporting the use of topical anesthetics for pain control in simple corneal abrasion after emergency department discharge

Your patient’s child poked him in the eye, and now he is in the most excruciating pain of his life. After a thorough eye exam, you determine he has a simple corneal abrasion. Your patient is ready for discharge, and has actually been pain free ever since you but 2 drops of tetracaine in the affected eye. “Hey, can you give me some of those amazing drops? They really worked!” You look down at this poor soul, and for some reason you say “no”.

Why don’t we use topical anesthetics for pain control in patients with simple corneal abrasions?

Continue reading “EBM Lecture Handout #2: Topical Anaesthetics fo Corneal Abrasions”

EBM Lecture Handout #3: Stress testing (part 1)

There are two handouts that cover the literature surrounding the use of exercise stress testing to risk stratify patients in the emergency department. For part one, I am posting, in its entirety, a critically appraised topic I did as a resident research project during my emergency medicine fellowship year. Part 2 can be found here.

Clinical Question

In emergency department chest pain patients with a normal electrocardiograms and negative cardiac biomarkers, can an exercise stress test predict short term risk for death or myocardial infarct? Continue reading “EBM Lecture Handout #3: Stress testing (part 1)”