Totally agree. We can critique the individual studies but given there is at least a signal of harm with etomidate (and not with ketamine) across many studies, the only reason to defend routine etomidate is inertia and comfort of learned practice. I use ketamine unless some contraindication now

RhD Immunoglobulin (e.g. RhoGAM) After First Trimester Abortion (spontaneous or induced) - I remember this debate in 2012 as a med student and now....many OB recommendations have changed! podcast is on spotify or wherever you listen foamcast.org/2025/03/22/r... #education #MedSky #EMSky #EMedSky

FOAMcast is baaaaaack. A major thought on asthma....we can and should do better for the patients we discharge from the ED... foamcast.org/2025/03/20/i... Listen on spotify, bit.ly/41CoxQF, or wherever you get your podcasts #education #MedSky #EMSky #EMedSky

Anticoagulant Selection Is Cornerstone of Pulmonary Embolism Treatment - ACEP Now ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an...

Let's get the basics right! Updates in anticoagulation selection in hospitalized patients with PE... www.acepnow.com/article/anti... #education #MedSky #EMSky #EMedSky

D-dimer for Ruling out PE in High-Risk Patients?
thesgem.com/2025/03/sgem... @lwestafer.bsky.social #MedSky #MemeMonday

Now recruiting for Resident Editorial Board Fellowship Appointment! #education #MedSky #EMSky #EMedSky #BlueSky

Failure rate of D-dimer testing in patients with high clinical probability of pulmonary embolism: Ancillary analysis of three European studies - PubMed In this study, ruling out PE in high-risk patients based on D-dimer below the age-adjusted threshold was safe, with no missed PE. However, the large CI of the primary endpoint precludes a definitive c...

Next up on the Skeptics' Guide to EM is this Hot Off the Press article on diagnosing pulmonary embolisms with @lwestafer.bsky.social #SGEMHOP #MedSky #EBM
pubmed.ncbi.nlm.nih.gov/39487597/

CJEM debate: clinical decision rules–thinking beyond the algorithm - Canadian Journal of Emergency Medicine Canadian Journal of Emergency Medicine -

Do clinical decision rules actually help with diagnosis in medicine?

The latest #CJEMDebate explores the question with
@first10em.bsky.social @emlitofnote.bsky.social @lwestafer.bsky.social @reverendofdoubt.bsky.social and @paulatkinsonem.bsky.social. #medsky

link.springer.com/article/10.1...

i have really appreciated your input - super informative! if you have any chest radiology colleagues that would be willing to chat with an EM/implementation science researcher, LMK

Thanks for the response! I’m interested in the cases where the report does not comment specifically on pulmonary embolism and just reports filling defect (which isn’t terribly uncommon in some groups)

for follow up: bsky.app/profile/lwes...

This is really interesting
What the qualitative studies says about EM providers and hospitalists is similar to what I used to hear
Practice needs to change to harm fewer patients, myths need to be busted

Question for radiologists (and others)...on CTPAs, if/when you use the term "filling defect" but don't specifically qualify PE yes or PE no, what does this mean/what is your certainty(%) that it is a PE? #MedSky #EMSky #EMedSky #radiology

Inhaled Corticosteroids An Underused Option for Asthma - ACEP Now ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an...

You routinely ensuring your patients in the ED with asthma exacerbations have an ICS? It's time we get on board www.acepnow.com/article/inha... #education #MedSky #EMSky #EMedSky #BlueSky

Misperceptions of pharmacology and advanced procedures was common. For example, the belief that anticoagulation is withheld during catheter directed thrombectomy was essentially ubiquitous. Lots of fun work to come in this space!

Surprisingly, although people had a general preference for one anticoagulant, they were pretty agnostic to the choice. There was this circular practice of EM starting UFH to allow HM more choices followed by therapeutic momentum (HM continues what ED started).

In @annalsofem.bsky.social we published on the shocking rise in UFH use for PE www.annemergmed.com/article/S019.... We wanted to know why, so we conducted a qual study out in @jama.com and found some interesting things jamanetwork.com/journals/jam... #education #MedSky #EMSky #EMedSky #BlueSky

Stay tuned to a forthcoming publication in JAMA network open 1/3/25 in which we studied this!

Does Andexanet Alpha Improve Outcomes Compared With Four-Factor Prothrombin Complex Concentrate for Reversal of Direct Oral Anticoagulants? www.annemergmed.com/article/S019... #education #MedSky #MedTwitter #EMSky #EMedSky #BlueSky

Guidelines recommend alternatives to UFH in acute PE bc unpredictable pharmacokinetics & resource intensity. we looked at nearly 300K pts hospitalized w/acute PE & found out UFH use has increased! www.annemergmed.com/article/S019... @annalsofem.bsky.social #education #MedSky #EMSky #EMedSky #BlueSky