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Brian Doyle
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Brian Doyle
Brian Doyle
ED consultant’s gestalt vs. screening tools for the prediction of sepsis in the critically ill8/12/2024 B Doyle This study sought to compare ED doctor’s gestalt vs screening tools to identify sepsis. The tools included SIRS, qSOFA, SOFA, MEWS, and a machine learning one called LASSO.
We would intuitively believe that these screening tools are an improvement over gestalt. Why would we use them if they weren't better? Oddly enough, the screening tools have never been compared to gestalt. What if they are worse? B Doyle On non-contrast head CT, a SAH is usually found by identifying the presence of bright white blood in the subarachnoid space. But over time, the blood becomes isodense and becomes more difficult to find. As such, we are generally happy to exclude SAH if we have a negative non-contrast head CT performed within 6 hours of headache onset. But what about a longer time window… is a CT adequately sensitive to exclude SAH up to 24 hours?
The Oakland Score to identify low risk patients with lower GI bleed that can be safely discharged8/12/2024 B Doyle The Oakland score was derived in 2015 but it somehow slipped my attention. The score is quite simple and mostly includes at a combination of age, vital signs and hemoglobin level to risk stratify patients [Oakland score MdCalc link].
B Doyle Have you ever ordered an ultrasound on a patient and had the report come back stating “appendix not visualised”? This seems to be a common and frustrating occurrence. We have historically considered this to be a result that doesn’t change our thought process, and we throw the report in the bin.
But what about the indirect signs of appendicitis that may be seen on ultrasound? If the appendix is inflamed, often so are the surrounding structures. Can the presence or absence of indirect signs change how we think about the post-test probability of disease? B Doyle The answer to some research questions are so glaringly obviousthat they really don’t need to be studied. Anyone who has done a haematoma block for a wrist fracture knows that they are a lot quicker and less resource intensive than a Bier’s block or procedural sedation. This is the major advantage of choosing a haematoma block over the other techniques.
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