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 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”
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”
Should we be starting PPIs on undifferentiated upper GI bleed patients in the emergency department prior to endoscopy?
Continue reading “EBM Lecture Handout #1: PPIs for GI Bleeds”
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”
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.
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)”