Nicholas Chrimes the co-creator of the much vaunted Vortex approach to the unanticipated difficult airway, released an excellent post on clinicalcred regarding the choice of preoxygenation device in the ED before intubation. Whether you agree with his conclusion that the Mapleson B device is the preferred option, it is an excellent discussion of the relevant considerations that need to be taken into account. Scott Weingart of emcrit then released a response podcast debating the conclusions of Chrimes. This was in very much a continuation of a debate that started in the comments section on our Bite-Sized Basics post on Preoxygenation.

The whole debate is worth following from the start to finish although I doubt this will be the end of it as the two come together for Airway discussions at SMACC this week.

Ryan Radecki from emlitofnote released a key post discussing a recent article in Nature that describes the abuse and misinterpretation of the p-value that has become endemic in the scientific community. Essentially we are putting far too much stock in p values without paying enough attention to the probability context in which the data is generated. Not all p values are equal and they should be considered more like likelihood ratios rather than exact estimations of truth or fiction. This is a must read and the full article is currently available for free here.

– Anand Swaminathan from emdocs reviews Frusemide in the treatment of Acute Pulmonary Oedema (APO). He looks at the evidence for harm and benefit and concludes there’s no clear evidence of benefit and some suggestion of harm so it really has no role in APO. The focus should be on early NIV (Non-invasive Ventilation) and nitroglycerine. I think there are different types of APO and for most I agree the role for frusemide is quite uncertain but the iatrogenic APO patient that a ward doctor may encounter who has been overloaded with IV fluids would probably find benefit from frusemide.

Do we really need them and if so when – find out in this review of the literature by Andrew Grock from ALIEM.

REBEL EM takes a look at the utility of the pelvic exam in the ED – perhaps may not be as useful as we thought.

This topic received an interesting update in a recent emcrit podcast suggesting an analgesia first, minimal sedation technique reduces delirium and improves outcomes. It was later further discussed and summarised by emdocs.

Seth Truger released an excellent screencast on Awake Intubation via laryngoscope published on PHARM – provides a stepwise approach to the procedure with handy tips and tricks.