💯💯 From my viewpoint in critical care the primary risk of the steroid protocol is (as I think you stated) diagnostic delays Every year we see several people who are seriously harmed by diagnostic failures 2/2 irrational fears of CT scans If you're critically ill we really need to know why, ASAP

Contrast may cause anaphylacTOID reactions (not anaphyLAXIS) (anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis) Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine This makes physiological sense! Thank you science! #1/3. #EMIMCC

Stop using steroids to pretreat CT contrast allergy youtube.com/watch?v=h2Hv...

Stop using steroids to pretreat contrast allergy! The CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity #FOAMed

Research Roundup (October 2025) There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…

Less is more when it comes to antibiotics. If you are still counselling your patients to take their full course, stop.

Amyloid-related imaging abnormalities: an emergency medicine nightmare? If you had asked me 5 years ago whether a disease modifying agent for Alzheimer’s disease would be developed, I would have laughed. “Moonshot; million to one; when pigs can fly”. Seems like I am as good at predicting the…

The First10EM Research Roundup for September 2025 It has been a while since I have critically appraised. Life without medical journals is sort of nice, but I guess it just isn’t me, so I am back and nerdier than ever. That means there are some strange selections this time around, but there are…

The continuing quest to treat numbers, not patients (OPTRESS) #FOAMed

In a beautiful park, by the ocean, on a sunny day, with my boy Remember why you do what you do

The First10EM wrap-up: Updates on the website, interesting media, good FOAMed, and random thoughts

If interested in ketamine for status, great debate emcrit.org/emcrit/ketam... @first10em.bsky.social vs @emcrit.bsky.social #EMIMCC

Noah Wiley on an episode of the the SGEM?? Absolutely crazy episode of FOAMed pca.st/episode/2558...

New World Screwworm It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed

This... is disturbing. Thanks for sharing this education... I think.

New World Screwworm It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed

The PECARN c-spine rule will cause a lot of harm (if anyone is silly enough to use it)

Is “First do no harm” a “deepity”?

For us it’s about exactly the elements in your last paper - recognising that sometimes the situation doesn’t fit the protocol or policy. The reporting provides an opportunity to ascertain whether the policy needs to change.

Nice! It might interest you to know that NSW ambulance has pathways for reporting and analysing “variance to practice”, another thing I think many hospitals could learn from.

My latest for @thestar.com, on the national crisis that doesn't seem to a part of the election. www.thestar.com/opinion/cont...

Thyroid storm diagnosis 1) TSH results can be delayed + not always available 2) Burch-Wartofsky scale: bedside clinical scoring system that requires no testing 3) High suspicion = immediate management youtube.com/shorts/E_U_V... #EMIMCC #MedSky

'Can you send me your "presentation"?' No. My slides are visual aids within my presentation. If your slides are so text-heavy that they contain all the information, you didn't do a presentation but a narrated collective document reading. Also, no you can't have my visual aids. Make your own.

The First10EM Research Roundup for April 2025 #FOAMed

The First10EM Research Roundup for April 2025 #FOAMed

Seeing many people confuse correlation with causation when it comes to vaccines & autism. Reminded me of this science joke. #MedSky

Canada comes second last out of 20 countries in new health-care ranking Seems like this should be an election priority ... Why such silence from our major parties?? financialpost.com/opinion/cana...

The pediatric can’t intubate can’t oxygenate scenario (Use a knife) #FOAMed

“what do you understand about your condition?” “only what they’ve told me” “what have they told you?” “it’s in my chart” “can you summarize it for me?” “doc, i’ve been a patient since before you were born. i know how to evade any question to conceal my cognitive decline. i can do this all day”

A pediatric transfusion dosing guide from McMaster Children's Hospital https://first10em.com/pediatric-transfusion-dosing/

Andexanet alfa: expensive and harmful?

I think a good way is to debrief with good judgement, let the learner to search for ways to improve in a sort of maieutic method. Many times there's no wrong or right but there's a mental process that has to be vivisected to find the answer. This is my short thought on the topic #FOAMed #EMIMCC

Providing feedback and defining excellence in medicine I need your help. How can I give better feedback? #FOAMed

Famous Billy quote about being an ER doc #MedSky

Now I went down the rabbit hole... www.propublica.org/article/musc...

Truth

I find this story fascinating 2 incredibly rare genetic disorders; one with dramatically different physical consequences And yet a woman recognizes the similarities based on pictures and badgers physicians/scientists until they prove her right www.durhamregion.com/news/the-ama...

Unless someone's got multiple clinical trials to cite, I stand by this rule

Just participated in Dr. Lin’s Synapse course. Amazing education!

is contrast nephropathy in the room with us right now? another article showing that contrast nephropathy isn’t a thing I wonder how long these articles will keep getting published, since I kinda thought this was settled 🤷‍♂️ https://www.jem-journal.com/article/S0736-4679(24)00372-X/abstract #EMIMCC

One of the smartest people I know in emergency medicine. #foamed #med #medsky #emimcc give her a follow to show her that this is the right social media space to be, and then reap the rewards of following a brilliant clinician

Today's talk at NYGH EMU: pediatric front of neck access Scary as hell, but I think the clear approach requires a scalpel first10em.com/pediatric-fr...

Overdiagnosis: Would we better better off not looking?

XX-ray normal is not a diagnosis" Run your differential diagnosis of MSK patients with normal appearing x-rays Of course, from Arun Sayal

If you want to get better at looking at x-rays, get better at looking at patients (The clinical exam is essential to scrutinizing the right area of the x-ray) Arun Sayal at the NYGH EMU conference

2 weeks in the ICU can save you 1 hour of difficult conversation

Scientists should try to repeat more studies, but not those looking for a link between vaccines with autism theconversation.com/scientists-s... @kaymd.bsky.social

hyperangulated videolaryngoscopy pearl: this is your daily reminder to *look* at the oropharynx while you’re passing the ETT through it. don’t stare anxiously at the screen while blindly jabbing at the oropharynx, waiting for the tube to magically appear on the screen. #EMIMCC

Meant is not said Said is not heard Heard is not understood Understood is not done

I enjoy teaching and learning about logical fallacies. It helps me think about the evidence better when trying to assess people's arguments for their positions. #MedSky