How to Think About Any Medication
An ER doctor’s framework for any medication: spot the 4 tricks used to scare you, then ask the 4 questions that actually matter. Evidence-based, no fearmongering.
The Silent Number: Should the Emergency Department Treat Asymptomatic Hypertension at All?
A high blood pressure reading in a patient who feels fine. New evidence on prescribing at discharge, what the guideline says, and what to do next.
Five Bottles, One Answer: Do Opioids Really Relieve Acute Musculoskeletal Pain Better?
A 600-patient RCT compared 5 oral analgesics for acute musculoskeletal pain. The opioid arms offered no extra relief, only more nausea. Here is the evidence.
The Paper That Made Me Rename Normal Saline
In the SALT-ED trial of 13,347 noncritically ill adults receiving IV fluids in the emergency department, balanced crystalloids (mainly lactated Ringer's) reduced major adverse kidney events at 30 days compared with normal saline (4.7% vs 5.6%; adjusted OR 0.82, 95% CI 0.70–0.95, P=0.01). There was no difference in hospital-free days. The proposed mechanism is the supraphysiologic chloride load in saline, which causes hyperchloremic metabolic acidosis.