Overheard In The Emergency Room

You think your patient has pneumonia, so you order a chest X-ray. Checked against CT, that film misses about 1 in 4 pneumonias. The ultrasound probe beside the bed, in trained hands, catches roughly 9 in 10. In this Overheard Journal Club, Dr Adrian Cois, an Emergency Physician, appraises Chavez and colleagues' 2014 meta-analysis in Respiratory Research: 10 studies, 1,172 adults, 94% sensitivi...

A man in his 40s came to my emergency department on a Sunday morning with an abscess. We drained it, checked his blood sugar because of where the abscess was, and it came back at 440. He went home with antibiotics, metformin, and a diagnosis of type 2 diabetes he had no idea he had. A number like that takes years to arrive. For most of those years, a routine blood test would have looked normal. Th...

A 66-year-old woman wakes up to find her right arm weak and heavy. Not paralyzed, just not quite hers. She decides she slept on it funny. Three hours later, it gets better, almost completely, and that is exactly what convinces her she is fine. She came in later anyway. Her MRI showed a small stroke that had already happened. This is the second episode in the "ER or Wait?" series, and it...

A patient came into my emergency room vomiting 10 times a day, two days after a semaglutide injection. They had just increased their dose. When I asked why, they did not know. It was what the app told them to do. Ozempic, Wegovy, Mounjaro and the rest of the GLP-1 family are the biggest story in medicine right now, and the conversation around them has collapsed into two camps. Half the internet ca...

Cardiovascular disease is the number one killer in the US and in Australia, and cholesterol is the most misunderstood set of numbers in medicine. On one side you have people insisting it does not matter at all. On the other you have people selling you a supplement to fix it. In this episode I take you through a standard lipid panel line by line. What each number actually measures, what the evidenc...

A patient is writhing on the bed, unable to lie still, pale with the pain. It is the textbook picture of renal colic, and the classic reflex is an IV in the arm, intravenous pain medication, and a trip down the hall for a CT. But what if the typical patient does not need all of that? This is Overheard Journal Club, where I take a paper I love, break it down, and tell you how it makes me think abou...

A man in his fifties sat at his kitchen table one night, certain he had bad indigestion. He took an antacid and went to bed. By the time he came to the Emergency Department several hours later, his ECG told a very different story, and those hours had cost him heart muscle we could never get back. Here is the uncomfortable truth at the center of that story. The person least able to tell whether che...

A patient of mine stopped taking his medication because of a 30-second video. An influencer with great lighting and zero medical training told him the pills were poison. A few months later, we met in my emergency department, dealing with the exact consequence we had been preventing all along.   This is the pillar episode for the whole medication series. It is not a defense of every drug, and it is...

A patient comes in for a laceration on her hand. Simple visit. Then the cuff cycles and the number thatcomes back is 182 over 112. She feels completely fine. No headache, no chest pain, nothing. And now there is a decision to make that is one of the more contested calls in emergency medicine. This is Overheard Journal Club, where I take a single paper I find genuinely interesting, break it down, a...

For most acute musculoskeletal injuries, the patient asks for something strong and we reach for the opioid almost by reflex. But is the opioid actually stronger? In this episode of Overheard Journal Club, I unpack a randomized trial of 600 emergency department patients that compared 5 common oral analgesic combinations, including two with no opioid at all, for acute pain in the arms and legs. The...

One red number at 11 p.m. cansend an otherwise healthy person into a full worst-case spiral before their doctor has even seen the result. In this Season 2 episode, Dr Cois walks through the framework physicians actually use to read a lab report: why a “normal range” isn’t the line between healthy and sick, why 1 in 20 healthy people flag on any given test, why how far out of range a value is matte...

Two patients came through the emergency department on the same shift. One waited 9 hours at home with chest pressure. One arrived at 3 am for a splinter. Both made the same mistake: neither had a way to answer the question, do I need to be seen right now, or not? In this episode, Dr. Cois shares the decision framework he uses to triage, simplified for home use. You will learn the one screening que...

For ten years I treated the bougie as a backup — the break-glass tool, Plan B. Then a 2024 systematic review and meta-analysis in Annals of Emergency Medicine made me reconsider whether it should be my first move on every airway. In this episode of Overheard Journal Club, I break down von Hellmann and colleagues’ pooled analysis of 18 studies and 9,151 patients: the headline 11% relative improveme...

A device can win a randomized trial and still be the wrong tool for your environment. In this episode of Overheard Journal Club, Dr Cois takes apart the 2024 JAMA cluster-randomized trial comparing video and direct laryngoscopy across 8,429 operating-room procedures. Video laryngoscopy cut multiple intubation attempts from 7.6 per cent to 1.7 per cent and reduced device-switch failures roughly fif...

In January 2025, a New York Times headline announced that fluoride exposure is linked to lower IQ in children. Within days, parents were tossing fluoride toothpaste and buying water filters, and a national political fight reignited over community water fluoridation. The paper behind the headline — Taylor et al, JAMA Pediatrics — is the largest and most rigorous meta-analysis of fluoride and childr...

Quick Hits Episode 6. A listener wrote in asking for a framework to read a medical paper — and it could not be timelier. Misinformation has now been ranked the most severe short-term risk facing the world by the World Economic Forum, ahead of armed conflict and cyber attacks. One in four Gen Z respondents turns to TikTok for medical advice, and viral medical content is consistently more likely to...

My pharmacy tried to charge me $90 for a generic nausea medication. Five minutes later, with a coupon I signed up for in the aisle, I paid $9. Same drug. Same store. Same five minutes. If that sounds impossible — or like a trick — this episode is for you. In Quick Hits Episode 5, I walk you through exactly how prescription drug pricing works in America, who is actually setting the price you pay (h...

Welcome to Overheard Journal Club. In this new short-form series, ED physician Dr Adrian Cois takes a single paper that's changed how he practises and breaks it down conversationally — PICO, results, critical appraisal, and the practical "so what do I do with this on my next shift" synthesis. First up: SALT-ED. Self and colleagues, NEJM 2018. A pragmatic crossover trial in 13,347 noncritically ill...

Two vehicles. Same destination. One question: which one will you actually do? If you’ve spent any time on health and fitness social media in the last two years, you’d be forgiven for thinking the only acceptable way to train your VO2 max is to strap on a weighted vest and grind out an hour of Zone 2 cardio every day. That’s what the algorithm is selling. The data tells a very different — and far m...

Welcome to the Season 1 finale of Overheard in the Emergency Room.   There's no single ED case anchoring this episode. There are fourteen of them — every patien every story, every lesson we walked through across the season. And rather than introduce one more case and pretend it summarises a whole year of conversations, Dr Cois pulls everything into a single playbook. Five Tier 1 pillars - in t...

If you work night shifts, swing shifts, or any schedule that doesn't line up with the sun, this Quick Hit is your sleep playbook. Dr Cois — emergency physician and host of Overheard in the Emergency Room — walks through the evidence-based system he uses for himself and shares with his patients. You'll learn why shift work nudges your long-term risk of diabetes, cardiovascular disease, and...

“Dr Cois, I’ve got abdominal pain. What will happen to me when I come to the ED?”  It’s one of the most common questions in my inbox — and one of the top 3 reasons people present to my Emergency Department. In this Quick Hit, I walk you through what actually happens when you come in with stomach pain: the conversation we have, the 4 diagnoses we cannot miss, and the bigger story most patients neve...

Welcome to the very first Quick Hit — a brand new bonus series from Overheard in the Emergency Room where Dr Cois tackles the questions you’ve been sending in. Short. Focused. Practical. Today: “What actually happens when I walk into the Emergency Department with chest pain?” Dr Cois walks you through the full chest pain workup — why we move so fast, what door-to balloon time means, the three body...

The global wellness industry is a 6.8-trillion-dollar business — more than four times the size of global pharma — and it runs on supplements. But how much of it actually has evidence behind it? In Episode 14 of Overheard in the Emergency Room, Dr Adrian Cois — a board-certified Emergency Physician — walks through the published systematic reviews and meta-analyses for the nine most common supplemen...

A 35-year-old patient walked into my Emergency Department with diverticulitis — and told me he was eating 2.2 grams of protein per kilogram of body weight per day because he heard it on a podcast. He had rearranged his entire diet around a number that was never meant for him, and in doing so, had displaced the exact foods that would have protected him from the diagnosis he was sitting in front of...