SGEM Xtra: The REBEL vs. The SKEPTIC at SMACC 2019

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Date: April 4th, 2020

It has been just over a year since Dr. Salim Razaie (REBEL EM) and I stepped into the ring for a boxing matched theme debate in Sydney, Australia. It was the EBM rumble down under for SMACC 2019. How the world has changed with COVID19.

You can see the original SGEM Xtra post from March 2019. It has more details about each issue we discussed and our slides.

This is being posted now because a high-definition video is available on YOUTUBE for those who could not attend or for those who want to watch this epic match again. It is an example of mixing education and entertainment for some great knowledge translation. You can also listen to an edited version on the SGEM iTunes feed.

We went four rounds punching and counter punching arguments about critical care controversies. The REBEL took the fight to the Skeptic. He supported his position with a flurry of publications.. The skeptic responded with his own citations. As with boxing, the champion must be beat, the challenger cannot win with a draw and there were no knockouts in the match.

The skeptic fell back on the burden of proof and asserted he had not been convinced to accept any of the REBELs claims. The ultimate winner was the patient. We both agree that the patient deserves the best care, based on the best evidence.

Four Critical Care Controversies:

Round#1: Mechanical CPR – SGEM#136

Round#2: Epinephrine in Out-of-Hospital Cardiac Arrest (OHCA) – SGEM#238

Round#3: Stroke Ambulances with CT Scanners

Round#4: Bougie for First Pass Intubation – SGEM#271

Conclusion/Winner – Use EBM and the winner is the patient

We appreciate Dr. Justin Morgenstern (First10EM) being the impartial referee for this contest. He ensured it was a good clean fight about the evidence and did not allow us to punch each other below the belt (in the p-value).

We encourage you to read the primary literature yourself. There are multiple links provided to the relevant studies in the original post. The literature should guide your care but it should not dictate your care. You will still need to apply your good clinical judgment and ask the patient what they value and prefer.

Thank you to all the students who supported me in the skeptical corner of the ring. I hope it encouraged their critical thinking skills. Not just to accept anything because their supervisor/attending told them. They also made sure I had plenty of maple syrup between the rounds.

The SGEM will be back next episode doing a structured critical appraisal of a recent publication. Trying to cut the knowledge translation window down from over ten years to less than one year using the power of social media. The ultimate goal is for patients get the best care, based on the best evidence.