Calciphylaxis In the Rapid Review series, I briefly review the key points of a clinical review paper (which often extends to multiple papers because I can’t help myself). The topic this time: Calciphylaxis The papers: Nigwekar SU, Thadhani R, Brandenburg VM. Calciphylaxis. N Engl J Med. 2018 May…

Has etomidate been killing people? Does ketamine cause cardiovascular collapse? Does the RSI trial settle these questions?? #FOAMed

Does coffee lead to atrial fibrillation | The DECAF trial You are at a conference. You had 1 glass of wine too many last night, so you had to add an extra coffee to get moving this morning. Then you feel a slight flutter in your chest. Caffeine is a stimulant, right? Could it be causing atrial…

Every day until Christmas, we're sharing a newly coined word from @drmattmorgan.bsky.social's medical lexicon Some are thoughtful. Some are quietly humorous. Today's word is Hospibrew: The distinctive hospital smell of equal parts reheated food and human waste www.bmj.com/content/391/...

The December 2025 FIrst10EM Research Roundup Get your #FOAMed #EBM fix with septic shock, bad data, contrast allergies, and even some rhinoceros pulmonary physiology

Under Trump, America is committing war crimes. But under Biden, there were irritating student protests at a college I did not attend. I have never felt more politically homeless.

The BroomeDocs First10EM JournalClub is out now on YouTube www.youtube.com/watch?v=tk3o... @broomedocs.bsky.social

Sweet’s Syndrome (aka acute febrile neutrophilic dermatosis) In the Rapid Review series, I briefly review the key points of a clinical review paper (which often extends to multiple papers because I can’t help myself). The topic this time: Sweet’s syndrome (aka acute febrile neutrophilic dermatosis)

When the parents in your kid's drama class strike up a conversation: "We don't do flu shots" "I found someone who will sell me homeopathic pellets" "When I took an extra Tylenol, I got liver pain, so I know this is safer" "Like, I don't know much about homeopathy, but it definitely works"

would not start antihypertensives. would discharge home immediately (it doesn’t seem like this admission is even indicated?) outpatient followup honestly this guy needs good outpatient management, not a fancy hospitalization that will be super expensive

I predict this will not be enough to convince some people: 285 studies 132 million people in real-world data 157,414 in randomized trials ~80% reduction in cervical cancer when given before age 16 No increase in serious adverse events @drjengunter.bsky.social www.eurekalert.org/news-release...

“I have been using a combination of cap refill and MAP since the original ANDROMEDA SHOCK paper” Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target. I fundamentally agree. Implementing imperfect data into practice is complicated. #EMIMCC

Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2) #FOAMed

💯💯 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...