ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Emergency medicine often lives in the gap between evidence-based practice and what actually works on shift. Real-world prescribing, abscess management, and symptom relief all force tradeoffs among trial data, patient adherence, follow-up, and comfort.
Evidence Versus Real-World Emergency Care
- Adherence over ideal dosing: Cephalexin four-times-daily dosing may fit the evidence, but twice-daily 1000 mg dosing reflects a common ED tradeoff when adherence is more realistic than a perfect prescription.
- Abscess packing habits: Routine abscess packing persists despite randomized data suggesting many cavities do not benefit, partly because training patterns and the built-in follow-up still influence bedside decisions.
- Sedation for symptom relief: Muscle relaxers or benzodiazepines may make acute pain more tolerable by reducing distress or creating grogginess, even when their direct analgesic effect is minimal.
- Experience alongside evidence: Years of clinical practice shape decisions when trials do not cleanly match the patient in front of you, a tension between external evidence and bedside judgment we get into in the episode.
- Practical bedside tradeoffs: Emergency clinicians constantly balance published evidence against feasibility, patient behavior, and comfort, especially when the technically best option is the least likely to work in real life.
Subscribe to ERcast: Clinical Perspectives to listen to the episode.
References:
- Newton K, Dumville J, Briggs M, et al. Postoperative Packing of Perianal Abscess Cavities (PPAC2): randomized clinical trial. Br J Surg. 2022;109(10):951-957. PMID: 35929816
Faculty
- Matthew DeLaney, MD, FACEP, FAAEM
Dr. Matthew DeLaney is an emergency medicine physician and educator based in Birmingham, Alabama. A native of Mobile, he earned his medical degree from the University of South Alabama and completed his emergency medicine residency at Maine Medical Center.Dr. DeLaney has experience in both community and academic emergency medicine and is known for his commitment to teaching and medical education. He lives in Birmingham with his wife, Erin, who is also a physician, and their two daughters.
- Drew Kalnow, DO
Dr. Drew Kalnow is an emergency medicine physician and educator based in Columbus, Ohio. He completed his emergency medicine training at OhioHealth Doctors Hospital Emergency Medicine Residency. Dr. Kalnow is passionate about advancing emergency medicine through high-quality education, with a particular focus on simulation, learning theory, and innovative teaching.
- Andy Little, DO
Dr. Andy Little is an emergency medicine physician and educator. He earned his medical degree from the Ohio University Heritage College of Osteopathic Medicine and completed his emergency medicine residency at OhioHealth Doctors Hospital Emergency Medicine Residency, where he served as Chief Resident. He has received multiple national awards, including recognition from the American Osteopathic Association, American College of Osteopathic Emergency Physicians, and Emergency Medicine Residents' Association.
