Drs Brian Driver and Matt Prekker join Rob Mac Sweeney to address some of the questions and comments that arose following the presentation and publication of the BOUGIE trial, comparing the use of a stylet with that of a bougie in emergency intubation.
Passing of Dr. James DarginNov 2021
April 16, 1978 ~ October 31, 2021 (age 43)
James Matthew Dargin, MD, 43, of Nashua, died unexpectedly at his home on October 31, 2021. He is the beloved husband of Elizabeth (Caron) Dargin with whom he shared fifteen joyful and blessed years of marriage.
Jim, as he was known to family and friends, was born in Nashua, NH on April 16, 1978. He is the son of John P. and Virginia (Breed) Dargin of Nashua. Jim attended Bishop Guertin High School and then enrolled at Boston University for his Bachelor in Science and in turn a Doctorate in Medicine. He also completed his residency at BU, in Emergency Medicine, at Boston Medical Center, while living in South Boston. Thereafter, he completed a fellowship in Critical Care at the University of Pittsburgh Medical Center before returning to New England to practice. An intensivist in Pulmonary and Critical Care, he served for the past eleven years as a physician at the Lahey Hospital and Medical Center in Burlington, MA. During that time, he held many leadership roles and was awarded multiple awards for his work, in addition to pursuing research, teaching, and mentoring others. He was highly regarded and admired by his colleagues for his deep commitment to his vocation as a physician, both in terms of his care of his patients and his teaching of future physicians.
Well beyond medicine, Jim had a great curiosity and desire for learning, whether from reading, conversation, or exploration. He loved fishing, and also watching Red Sox and Patriots games with friends and family. Absolutely above all else, he cherished time spent with family, especially with his wife and children. He will forever be remembered as the strong and loving family man he was.
In addition to his parents John and Virginia, and his wife Beth, Jim is survived by his two daughters, Paige Marie and Meredith Ann Dargin of Nashua; his brother, John P. Dargin and his wife Kathie of Nashua and his nieces, Brianna and Emma; his sister-in-law, Jennifer Matsis of Milford and his nieces Alexandra and Ashleigh; his aunt, Ann Scalcione and her husband Robert; two uncles, Paul Dargin and Joseph Breed, as well as many cousins and extended family. Jim was predeceased by his in-laws, Normand and Sandra Caron.
Relatives and friends are invited to Jim’s visitation on SUNDAY, November 7th from 3-6 PM at ROCHETTE FUNERAL HOME AND CREMATION SERVICES, 21 Kinsley Street, Nashua.
His funeral Mass will be held on MONDAY, November 8th at 10 AM at St. Joseph the Worker Parish, 777 W Hollis Street, Nashua. Interment will follow in St. Louis Cemetery, Nashua. In lieu of flowers, donations may be made in Jim’s name to Beth Israel Lahey Health, please visit
Embedding Pragmatic Trials into Emergency and Critical Care (Matthew W. Semler, MD, MSc; Jonathan D. Casey, MD, MSc)Oct 2021
|Embedding Pragmatic Trials into Emergency and Critical Care (Matthew W. Semler, MD, MSc; Jonathan D. Casey, MD, MSc)10/29/20210 CommentsSlidesSpeakers|
Matthew W. Semler, MD, MSc
Vanderbilt University Medical Center
Jonathan D. Casey, MD, MSc
Vanderbilt University Medical Center
TopicEmbedding Pragmatic Trials into Emergency and Critical CareKeywordsPragmatic clinical trials; Study design; Comparative effectiveness trials; Treatment effect; SMART trial; PreVent trial; Exception from Informed Consent (EFIC)
Key PointsEmergency medical clinicians are faced with common decisions in everyday practice with little to no data from randomized clinical trials to help inform their decisions.Four barriers to comparative effectiveness trials in a critical care setting are a brief therapeutic window, patients with multiple co-morbidities, the inability of the patient to consent to research, and analyzing average treatment effect rather than individual treatment effect.The PreVent Trial studied the use of bag-mask ventilation to prevent hypoxemia for patients who had been administered anesthesia in preparation for intubation.Efficient, pragmatic trial procedures that don’t delay treatment enable comparative effectiveness randomized clinical trials to be conducted effectively.After 50 years of debate about bag-mask ventilation during this interval period, the PreVent Trial found that bag-mask ventilation cut the rate of hypoxemia by 50% without affecting aspiration.The SMART Trial was a cluster-randomized, multiple-crossover trial of fluid management that studied patient outcomes when Balanced Crystalloids were used versus Saline solution.The large sample size of over 15,000 patients provided the SMART trial with the power to detect that a balanced crystalloid fluid prevented Major Adverse Kidney Events in 1% of patients compared to Saline solution. /li>Exception from Informed Consent (EFIC), implemented in 1996 allows trials in emergency situations of the condition is life-threatening, existing treatments are unproven or unsatisfactory, and research involves no more than minimal risk.Analyzing Individual Treatment Effects will allow clinical providers to tailor their decisions to their individual patient.Discussion ThemesClinical equipoise poses a challenge for comparative effectiveness trials.
Key to getting buy-in from clinician stakeholders is explaining the importance of the research to the pat
ICU doctor ‘frustrated’ as COVID hospitalizations spike in TennesseeSep 2021
By: Emily Luxen
NASHVILLE, Tenn. (WTVF) — As the Labor Day weekend concludes, Tennessee continues to see a record-breaking number of people hospitalized with COVID-19.
The latest data from the Tennessee Department of Health reveals there are now 3,597 COVID patients hospitalized across the state. Of those, 1,020 are in ICUs. Before this record influx of COVID patients, the previous record was set back in January.
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The most recent numbers from Vanderbilt University Medical Center show of the 218 people hospitalized over the last 7 days, 190 were unvaccinated.
“We’re seeing lots of lots people who are unvaccinated who are sick enough to be in the hospital,” said Dr. Todd Rice, a critical care physician at Vanderbilt University Medical Center. “There is some exasperation from nurses. It’s like if you just would have got vaccinated, you likely wouldn’t be here.”
Dr. Rice has been treating COVID patients since the beginning of the pandemic. He said 18 months of grueling work has taken a toll on hospital staff.
“These patients are sick,” said Dr. Rice. “They take a ton of resources, energy and time.”
Dr. Rice said doctors are also waiting to see if travel and other activities over the Labor Day weekend cause yet another spike in cases.
“Our numbers are high enough right now, I think any increase we see gets buried in the high numbers right now.”
Dr. Rice said the only way to reverse the trend is for more Tennesseans to get vaccinated. He said some unvaccinated patients have expressed regrets they didn’t get the shot, and he hopes others learn from their actions.
“There is no better way to make sure you don’t get COVID and don’t end up in the hospital than to get yourself vaccinated,” said Dr. Rice.
The Path Forward: Building on Lessons Learned from the COVID-19 PandemicJul 2021
Mastering Intensive Care Episode 66: Todd Rice – Learning and teaching how to “not just do something, stand there”Feb 2021
This wide-ranging episode, covering many angles of how we should consider doing less interventions to our patients and more transparent communication to their families, features US intensivist Todd Rice.