TamingtheSRU

Cardiac arrest care hinges on high‑quality CPR, but pulse checks remain a stubborn source of interruptions — often longer than the recommended 10 seconds and repeated every two minutes. What if we could detect ROSC without ever pausing compressions? This diagnostic accuracy study evaluates whether femoral arterial Doppler waveforms obtained during active CPR can predict arterial line pulsatility a...

Diabetic ketoacidosis is a familiar ED diagnosis, but the best fluid strategy is still up for debate. Many of us default to the traditional one‑bag system, even though it can be slow to adjust and prone to glucose swings. This new meta‑analysis compares one‑bag versus two‑bag DKA management across adults and children, examining hypoglycemia rates, time to resolution, and operational impact. Join D...

Point‑of‑care echo is fast, powerful—and famously operator‑dependent. Most of us rely on quick visual impressions because precise measurements take time we often don’t have. This new study puts three automated, real‑time AI tools to the test, comparing their ejection fraction, VTI, and IVC assessments against an expert’s read. Join Dr. Sookdeo as she breaks down how well the algorithms performed a...

Documentation load is a major driver of burnout in emergency medicine, and the ED’s pace only intensifies the pressure. Ambient AI scribes offer a hands‑free way to capture encounters and ease charting—but how often are these tools actually used, and do they meaningfully change documentation time? Join Dr. Kopel as she unpacks what early use reveals about the promise and limitations of AI‑generate...

Survival after out‑of‑hospital cardiac arrest hinges often on getting an AED to the patient within minutes - but in most communities (especially more rural areas), that simply doesn’t happen fast enough. First responders often arrive too late, and bystanders rarely have immediate access to a device. This study explores whether pairing first responders with strategically deployed AED‑carrying drone...

Ground-level falls are a leading reason older adults get head CTs in the ER, largely because current rules treat age > 65 as a risk factor by itself. Yet many emergency physicians question whether that’s always necessary for well-appearing patients. A new systematic review and meta-analysis in Annals of Emergency Medicine digs deeper, asking: what other factors truly predict intracranial hemorrhag...

Tranexamic acid (TXA) is an anti-fibrinolytic that may reduce hemorrhage and improve survival in trauma. While early studies raised safety concerns, newer evidence supports its use in select patients. Join Dr. Segev as he reviews key TXA trials and highlights the updated EAST guidelines on pre-hospital and in-hospital administration.

Gastrointestinal bleeding is a frequent and potentially life-threatening presentation in the ED. With CT angiography increasingly being used as a first-line diagnostic tool, are we improving detection or simply overusing imaging? Join Dr. Guillaume as she discusses this recent JAMA Network Open study examining trends in CTA utilization for GI bleeding and whether rising scan rates are truly leadin...

Pyelonephritis is a commonly treated diagnosis in the emergency department. With resistance rates climbing to the first-line recommended fluoroquinolones and Bactrim, are other antibiotics appropriate in treating pyelonephritis? Join Dr Gabor as she discusses this article and its treatment recommendations for outpatient pyelonephritis with cephalosporins and how it compares to treatment with the m...

Septic shock remains a leading cause of pediatric mortality, but the choice of first-line vasoactive agent has long been debated. Dr Newton, a PGY-3, discusses this single-center retrospective cohort study comparing epinephrine and norepinephrine as initial infusions in children with septic shock. While the primary kidney outcome (MAKE30) showed no difference, epinephrine was linked to higher 30-d...

In the ED, your words can be as powerful as your meds. In this episode, PGY-3 Dr Kotel unpacks the science of placebo and nocebo, showing how communication shapes patient outcomes—and how small shifts in framing, empathy, and reassurance can turn talk into treatment.

Lung-protective ventilation (LPV), characterized by low tidal volumes and appropriate PEEP, is a cornerstone in managing patients with acute respiratory distress syndrome (ARDS). However, its application in patients with severe acute brain injury raises concerns. The potential for lung protective ventilation to increase intracranial pressure due to hypercapnia and elevated PEEP levels necessitates...

Many clinical decision rules exclude elderly patients from the derivation cohorts. So the question remains unanswered do all elderly patients need cervical spine CTs in the setting of trauma? What if they have no symptoms? This recap of a journal club article explores the incidence of significant cervical spine fractures in elderly patients.

It is well known that ultrasound has exploded in its application in both diagnostics and procedures and has ultimately revolutionized the way we practice medicine. With its growing use, more and more providers are comfortable using ultrasound for both identification of anatomy/pathology and to guide procedures that were previously only done with landmarks. While having the skills to perform landma...

More than 1.5 million critically ill adults undergo tracheal intubation each year in the United States. Hypoxemia is a common and serious complication during tracheal intubation in critically ill adults, occurring up to 10-20% of intubations in the emergency department (ED) or intensive care unit (ICU). Hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with non...

Severe trauma is the leading cause of death worldwide for adults younger than 50 years of age. Acute traumatic life support (ATLS) guidelines endorse early and aggressive usage of supplemental oxygen in patients with severe trauma, at least until abnormalities of airway or breathing can be safely ruled out. However, unclear target concentration, duration or saturation goals often leads to hyperoxe...

We know that the d-dimer can be a helpful test for patients who have a low pre-test probability of pulmonary embolism. But can the test be pushed into use for higher risk patients? Will it still have useful negative predictive value or will we risk missing too many PEs?

Can a nitro slurry help with food bolus impaction? Glucagon and effervescent beverages have limited evidence for benefit. Can an old drug used in a new way help these patients?

Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. This study substituted age adjusted vital sign measures and a pediatric shock index into currently existing pediatric sepsis scoring systems to create the qPS4.When utilizing a cut off of ≧ 2 points, the qPS4 was highly sensitive and specific, and identified pediatric septic shock far sooner int...

There is a wide variation in practice, particularly in obtaining neuro-imaging in patients presenting with vertigo. Many patients are imaged and subjected to a longer length of stay, and on the other side of the coin, some patients with serious pathology fall through the cracks. The authors of this study set out to create a risk score to apply to patients who present to the ED with vertigo which w...

Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well  as the rest of the world. Sepsis as a disease process has been difficult to both clearly define and quickly recognize. Many metrics for recognition and management of sepsis are dependent upon various scoring systems, including SIRS, SOFA, qSOFA, and...

In patients with cirrhosis and ongoing bleeding, it can be challenging to determine whether or not patients are hyper or hypocoagulable. Traditional markers of coagulation status like INR can be difficult to interpret in patients with abnormal synthetic function and potentially increase consumption of coagulation factors. Can TEG (thromboelastography) be a helpful too in these situations? In this...

In this journal club recap, Dr Sarah Moulds recaps a recent meta-analysis of papers looking at the therapeutic effect of TXA in patients with severe trauma. Are their higher rates of thromboembolic complications? Is mortality improved? This article by Fouche et al attempts to answer these questions.

Out of hospital cardiac arrest (OOHCA) represents a great cause of morbidity and mortality. Approximately 350,000 cardiac arrests occur in North America annually and 20% can be attributed to Ventricular tachydysrhythmias (i.e. ventricular tachycardia [v fib] and ventricular tachycardia [v tach]without a pulse). In this journal club recap, Dr Kelly Tillotson recaps an article comparing different wa...

In this most recent Journal Club recap podcast, Dr. Cole Davis covers a paper investigating the use of sterile vs clean gloves for laceration repair in the ED.