Rory Spiegel

[Rory Spiegel @TheEMNerd]

Can the YEARS Criteria safely rule out PE in cancer patients? The new Hydra trial (JAMA) says yes... but the details tells a more nuanced story about how well YEARS actually risk-stratifies these patients. New post on EM Nerd https://t.co/KbkSvPi5nw

[Rory Spiegel @TheEMNerd]

Can the YEARS Criteria safely rule out PE in cancer patients? The new Hydra trial (JAMA) says yes... but the data underneath tells a more nuanced story about how well YEARS actually risk-stratifies these patients

Full Thread on Roon
https://t.co/JAWaHVWILG

[Rory Spiegel @TheEMNerd]

Is normal saline harmful in the critically ill?
34,685 patients, one meta-analysis, and four different answers depending on how you ask the question.
A thread on BEST-Living and what "probability of benefit" actually means. https://t.co/NEK1zt5ZdV

[Rory Spiegel @TheEMNerd]

Full thread at https://t.co/yGPNpj0LCQ

[Rory Spiegel @TheEMNerd]

https://t.co/UqRVMu7yBR
A 2026 meta-analysis shows PCT-guided antibiotic decreases antibiotics by 2 days in sepsis. But standard care moving towards shorter courses of antibiotics. Is PCT still adding value, or just beating a comparator that's already becoming obsolete?

[Rory Spiegel @TheEMNerd]

@PulmCrit The mere fact so many sites in this trial opted out of the no-drug arm because they believed in its benefits so strongly, even with zero prior studies examining its use in this population and its seemingly meager benefits at best in the general influenza population, is troubling

[Rory Spiegel @TheEMNerd]

@PulmCrit That being said, the default stance that oseltamivir should be used in the critically ill is concerning.

[Rory Spiegel @TheEMNerd]

“This post will be mauled by Bayesian statisticians. That's OK, go ahead. I am tired of being gaslit by statisticians saying that Bayesian calculus can somehow convert a p-value of 0.4 into 97% certainty.” Brilliant line!

[Josh Farkas MD 💊 @PulmCrit]

Fresh Blog: Is oseltamivir assassinating ICU patients?

The REMAP-CAP trial has concluded with >98% certainty that oseltamivir is killing patients.

This is an extraordinary claim that requires extraordinary evidence.

#1/2... (link to blog in 2nd post)

[Ashley Miller @icmteaching]

https://t.co/ZLSBqt7KMV

[Rory Spiegel @TheEMNerd]

@AnilMakam Or just random chance. Which given the CIs is a fairly high probability

[Philippe Rola @ThinkingCC]

No. Check for tolerance first. Responsiveness does not equal need, nor benefit. Maximizing output was shown decades ago to not be a viable strategy. Optimize tissue perfusion. Learners, please reconsider a forward-flow-centric approach. Focus on tissue perfusion, and the two do NOT have a linear relationship. Understand hemodynamic interfaces. Ping @icmteaching @khaycock2 @EMNerd_ @edu_kattan @ross_prager

[Rory Spiegel @TheEMNerd]

@EM_phile @ThinkingCC

[Rory Spiegel @TheEMNerd]

SODa-BIC just dropped in NEJM. The large, rigorous RCT examining the use of sodium bicarbonate ICU patients with shock and acidosis.

https://t.co/oil4MPDsDU

[Rory Spiegel @TheEMNerd]

@DanielJafari Sure but that only holds if you choose to initiate CRRT for a pH< 7.2. If we admit there is no evidence to justify dialysis for a pH alone than it’s not really a relevant endpoint.

[Rory Spiegel @TheEMNerd]

@DanielJafari If you look at table E5 most of the excess RRT was due to a pH< 7.2.

[Rory Spiegel @TheEMNerd]

@DanielJafari Yes but even than they failed to really demonstrate a meaningful difference

[Rory Spiegel @TheEMNerd]

@AndyDeitch That’s only if you decide to put them on pump due to acidosis. But if acidosis (at least at these levels) doesn’t effect the other outcomes we care about then why bother

[Rory Spiegel @TheEMNerd]

@jasumback

[Rory Spiegel @TheEMNerd]

@icmteaching Fair point, I'll add this to the Roasties recipe ;)

[Rory Spiegel @TheEMNerd]

@nickmmark Adding 2 tablespoons of baking soda to water when parboiling the potatoes prior to roasting leads to greater breakdown of the surface of the potato, leading to more surfaces area to crisp up during the roasting process