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PulmCrit Hot Take: PRAGUE-26 RCT on catheter-directed thrombolysis for intermediate-high risk PE
Another MC-RCT just dropped on catheter-directed tPA for intermediate-high risk PE patients. It’s overall pretty similar to the HI-PEITHO trial (previously discussed here). I doubt it will change much, because most people are already pretty dug in on their positions on intermediate-high risk PE. Nonetheless, this is a large MC-RCT, and it deserves some discussion. […]
The Five Laws of Medical Robotics
The Five Laws of Medical Robotics JAMA recently published a Perspective titled “Will Autonomous AI Exceed AI-Aided Physicians as the Best Medical Care?” by Ezekiel Emanuel, Abe Baker-Butler, Neal Khosla, and Vinod Khosla.1 Their thesis stated plainly, physician-AI hybrids, the model every major medical society currently endorses, will be replaced by autonomous AI, operating independently […]
A Field Guide to Evidence Based Medicine – Episode 2 – Chloride Continued…
The chloride saga continues…
EMCrit 432 – Members’ Airway Cases and Q&A
I dive deep into member-submitted airway nightmares, breaking down how to manage petrified “airway concrete” and high-risk hypoxemia. Learn how to apply the CHOP criteria, avoid physiological arrest during induction in cardiogenic shock, and handle extreme metabolic acidosis.
The Case of the Neutral Documents Part 2
This particular story has a familiar shape. A small, methodologically flawed study finds a striking benefit. The p-value is impressively low. The paper lands in a major journal. And within a few years, its flaws, its obvious sources of bias, and its undeniable susceptibility to chance findings are forgotten. All that remains is its statistical […]
The Case of the Redacted Ledger
Given the history of bad faith shenanigans undertaken by Roche to hide the borderline efficacy of oseltamivir in an effort to maximize profits, the results of REMAP-CAP should come as a surprise to no one. Throughout the years of their ongoing subterfuge, no randomized controlled trial (RCT) was ever performed examining the efficacy of oseltamivir […]
EMCrit 431 – OB-EMCrit – Life-Threatening Post-Partum Hemorrhage (PPH) with Cho Espinoza
Dr. Cho Espinosaâsurgical intensivist, OB-GYN, and flight docâjoins me to overhaul how we handle catastrophic post-partum hemorrhage. Moving past standard ivory-tower guidelines, Cho dives deep into high-yield uterotonic administration, physical compression techniques, and aggressive coagulopathy management. Learn how to temporize severe obstetric exsanguination when you are the only resuscitationist in the room.
A Slow Retreat
Imagine, for a moment, that targeted temperature management (TTM), the standard of care in post cardiac arrest management for more than two decades, was built on a false premise from the very beginning. Not a hypothesis gradually refined by better evidence, but one whose foundation was fundamentally flawed. The evidentiary basis for TTM rests on […]
PulmCrit Wee: Four reasons that hyperangulated videolaryngoscopy should be the mainstay of ICU intubations
As glorious as direct laryngoscopy was, it’s time to transition to hyperangulated videolaryngoscopy as the mainstay of intubation among critically ill patients. There are a few reasons for this. [#1/4] People don’t do videolaryngoscopy with a MAC blade correctly When videolargynosocopy with a MAC blade came out (hereafter referred to as MAC-VL), it seemed like […]
A Study in Priors Part 2
In our previous post, we explored some of the more nuanced considerations when interpreting Bayesian analyses. In Part 2, weâll apply those concepts to a recently published Bayesian individual patient data (IPD) meta-analysis comparing normal saline with balanced crystalloids in critically ill patients, the BEST-Living meta-analysis by Zampieri et al., published in The Lancet Respiratory […]
A Field Guide to Evidence Based Medicine Podcast – Episode 1
Rory and Jerry Hoffman host the inaugural episode of a new podcast
EMCrit 430 – Questions and Answers (Members Q&A Episode 004) with Sara Crager
In this episode of EMCrit, Dr. Sarah Crager joins me to break down down-and-dirty bedside shock management, moving beyond simple blood pressure targets to a dynamic “shifting gears” forward-flow mental model. They tackle tough clinical dilemmas, including the debate over lactated Ringerâs in lactic acidosis, the nuanced use of albumin and diuretics in edematous patients, and the real-world application of epinephrine and so much more…
A Study in Priors
There is a replication crisis in the medical literature. Nearly half of all positive trials, when repeated, do not produce a similar positive result.Âđ,Âē While many reasons have been posited for this lack of reproducibility, including publication bias, p-hacking, underpowered studies, and selective reporting, what it ultimately means is that we cannot trust the results […]
The Case of the Malignant Cohort
The YEARS protocol has gained popularity as a straightforward approach to identify a subset of patients undergoing a workup for suspected pulmonary embolism (PE) who are at sufficiently low risk to safely use a D-dimer threshold of 1000 ng/mL. Despite its success, questions remain about whether this strategy can be safely applied to patients with […]
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