Category: The Homunculus

Less is More

I had wanted to write on the utility and interpretation of serial CBCs.   I do it all the time and I’m sure my practice is not well-informed.  However, it’s doing.  It’s active. And we love doing. (Check out Drs Sinert…

All pressure is created equal

That moment when an idea strikes you. Something stutters the laminar flow of the mind. A mental murmur, perhaps. It’s that hiccup that alerts you that something’s up, something needs to be reassessed.   This happened to me at Janus…

The “Soft” Code

EMS notification. 115 year old female in cardiac arrest. ACLS in progress. Estimated time of arrival: 5 minutes. Your stomach groans. Upon EMS arrival, you learn that she comes from a nursing facility and has end-stage dementia; she is bed-bound,…

To Cath or Not to Cath

  Quick case: It’s 3am.  A 55yM, with a pmhx of chubbiness, DM, HTN is brought in by EMS after being found down.  He is pulse-less, with an initial rhythm of ventricular fibrillation.  He is shocked appropriately and exquisite ACLS…

Levophed-openia

The debate on the treatment of circulatory shock is over(-ish?).  Ever since the NEJM put out its big RCT on the treatment of all-comer shock[i], we know that norepinephrine is the vasopressor of choice.  Septic, cardiogenic….doesn’t matter.  Norepinephrine is superior…

Fever…Huh

What is it good for?   Something?  Maybe?  Remember in medical school when the right answer to everything was cytokines.  The mythical inflammatory response; all those interleukins, TNFs, and all other forms of molecular magic that drive our response to…

Evidence-Lite Medicine

A few weeks ago, Dr Harriott gave a talk on out-of-hospital cardiac arrest (OHCA) and pre-hospital airway management.  She reviewed some historical context for the current EMS system and airway management. Her literature search suggested that for OHCA, paramedic-operated endotracheal…

Hating on pulse-ox

We like to think we’re always practicing evidence-based medicine.  So we inform our consultants about likelihood ratios and ask how can they be “so sure.”  We try to be very aware of the sensitivities and specificities of the tests we…