The Skeptics Guide to Emergency Medicine SGEM Xtra: 5 Papers in 15 Minutes (Incrementum 2025)
Mar 23, 2025
A recent talk explored five pivotal studies in emergency medicine, offering insights into innovative pre-oxygenation techniques and the reliability of various trial methodologies. Key highlights included a critical analysis of pediatric cervical spine injuries and the effectiveness of pre-hospital sedation. The discussion also delved into the challenges posed by publication bias and the importance of addressing anticoagulant reversal in hemorrhage cases, making for a compelling and informative session.
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Non-Invasive Ventilation Reduces Hypoxemia
- Non-invasive ventilation for pre-oxygenation reduces hypoxemia in critically ill intubation patients compared to oxygen masks.
- Benefit is clearer in ICU, less so in ED, and study limitations include lack of masking and potential selection bias.
Skepticism Needed for Single-Center RCTs
- Only 6% of single-center RCTs reporting mortality benefit were confirmed by multi-center RCTs.
- This challenges trust in small trials and highlights risks of publication bias and non-generalizability.
No Best Pediatric C-Spine Rule
- Pediatric cervical spine injury clinical decision rules are highly sensitive but poorly specific.
- No single rule outperforms others; clinical context and judgment remain essential.