Street Stats: The Bonferroni Correction

Tl;dr: (1) Expected false positive rate for any one statistical test is generally 0.05 (aka, alpha). But this error compounds when you run multiple statistical tests. (2) Adjust your target p-value by applying the Bonferonni correction (0.05/n where n = # statistical to tests) to see if authors’ findings are truly consistent with their reportedRead more

Core Content: Critical actions for the preeclamptic patient

Tl;dr: (1) Don’t forget to order a uric acid with the labs as it increases the specificity in diagnosing preeclampsia. (2) If the pt is preeclamptic with severe features (see below), then give 4g IV Mg followed by 1-2gr/hr infusion for 24hrs. (3) Unlike other hypertensive emergencies, start with push dose meds rather than ourRead more

Difficult placement of an OGT? Try an ET tube introducer

Tl;dr: Failed OGT placement in an intubated patient is common. Try using an 8.0 ETT as an introducer into the esophagus to prevent coiling in the mouth / upper esophagus.   Placement of an OGT or NGT can often be challenging in an intubated patient since we can’t ask them to swallow during the procedure.Read more

Applying the Pelvic Binder: Pearls and Pitfalls

Tl;dr: (1) Never rock the pelvis. Firmly squeeze and hold. (2) Consider quickly assessing for rectal or vaginal bleeding prior to binder application as this would suggest an open fx into the vag / rectal vault. It will be difficult to complete the exam once the binder is on. (3) The binder is applied overRead more

The Supraclavicular Subclavian

Traditionally, central line placement in the subclavian vein (SCV) involves a landmark-based approach in which the needle is guided under the clavicle. For the U/S lovers, there is an alternative approach to the subclavian in which the sono may be utilized: the supraclavicular subclavian. Anatomy: The goal is to cannulate the SCV just lateral toRead more

Paper Review: Are we hurting patients via oxygen supplementation?

Bottom line up front: A recent large, high quality meta-analysis reported a significant mortality effect with the use of liberal, rather than conservative, oxygen supplementation. The number needed harm for 30-day mortality was 1 in 126. A modest but relevant NNH given how common oxygen supplementation is in the ER. Consider titrating all forms ofRead more

The Neuroprotective Intubation

Bottom line up front: (1) Intubating those with TBI or spontaneous ICH is dangerous. You want to prevent increased ICP that is caused by laryngoscopy. (2) Pre-treat with fentanyl if time and the pt’s BP allow. The dose of fentanyl is larger than we are used to, dose 3 mcg/kg (or ~150-200mcg). (3) It isRead more