Incision & Drainage

Welcome to Incision and Drainage.  We’re going to drain some pus and blood.

Of course, we’ll talk about a lot of things, but if I do my job right, most of the topics will be provocative. I like controversies in medicine and health care. I like the fuzzy gray areas, where the laminar flow of clear-cut clinical decisions degenerates into turbulence, where the evidence (or lack thereof) supports more than one point of view.

So I should have plenty of stuff to bloviate about, as is my wont. Why the hell would we give vitamin K to any human patient? Do we really believe ECASS 3 and push t-PA at 4.5 hours? After more than a quarter century, why do we still wring our hands over who should get a head CT?  Why does Lewalski wear red shoes? What’s he trying to say? More or less fluids for hemorrhagic shock? Do we really need more EM subspecialties? Hell—do we need the ones we’ve got? Why is it, exactly, that a patient in the ED “belongs” to a particular doctor, but not to a particular nurse? Is it rational, or even ethical, to board patients in our ED when a growing body of literature says we shouldn’t?

Oh, yes, there’s plenty to talk about. Plenty to argue about. Plenty to get hot about. And I’m the kind of guy who believes that a really successful journal club is the one that ends with a fist fight. Laminar flow is boring. Turbulence is mysterious, maddening,  and beautiful.
So that’s what I hope to do with this column. Create turbulence.