Sucrose is not a pain medication YouTube video by First10EM

Sucrose is not a pain medication
A big mistake commonly made in pediatrics, based in good intentions, but with egregious results

youtu.be/s6Ort-zU8lw

Absolutely
It's been a while since I reviewed them
It's good feedback
I do hate them.. so maybe I'll just go back to eating the costs

And to be clear: I hate the ads

I just also hate the finances of FOAMed

It's a constant debate which is worse - but regular users of the site have told me over and over again that they don't mind the ads

Definitely don't want to ruin the usability of the site

And I am very conscious of the type of ads that are run. A lot more $ is available, but I won't display any ads that are related at all to medicine

But covering the expenses feels worthwhile

It's not just hosting costs
Costs for design / images / add-ons
Depends on what you mean by expensive, but a couple grand a year out of pocket for a project that already eats 100 hours a month of volunteer time feels like a lot, and I would prefer to have it covered

Awesome
I prefer no adds
But I also prefer to break even on a website that is actually somewhat expensive to run

Don't know the best approach

Very fair
Ads are supposed to be set at the minimum possible settings - max one per page - but google like to automatically increase that and I don't notice because I have ad blockers on all my devices

Been planning a redesign / change to the entire site for years, but who has the time?

Higher risk PE management updates (The STRATIFY and STORM-PE trials) I have written fairly extensively about the management of high risk PE. Despite their growing popularity, I have remained quite skeptical of catheter directed therapies. If you are going to give a thrombolytic, my sense is that it is going to be just as effective if given through a peripheral vein, and that fancy catheters add nothing but risk and cost.

2 new RCTs looking at interventional approaches to pulmonary embolism
Do you have access to these tools? Should you use them? #FOAMed

Blood pressure targets in spinal cord injury (Treat patients not numbers) Although guidelines have long suggested higher blood pressure targets in spinal cord injury, that recommendation has never been based on high quality evidence. (Walters 2013; Sanchez 2020) (This is the first ever RCT.) We have a bad habit of treating numbers in medicine, and often making things worse. (Remember the recent paper discussing worse outcomes when we lower blood pressure in ICH, for example…

Yet again, treating numbers doesn't help
This time, we have the first RCT looking at blood pressure targets in spinal cord injury

Yeah
I think that is definitely the aspect I was overlooking
I thought these patients were excluded, but rereading it now - they probably weren't

Prehospital plasma in trauma (PAMPer) - First10EM A critical appraisal of the PAMPer trial. (Plasma in the prehospital environment for trauma).

For sure - the plasma outcomes have been decidedly mixed thus far
From unbelievably good: first10em.com/pamper/
To not good at all: first10em.com/combat-moore...
Hard to know how it affects these outcomes

They were supposed to be excluded if they received blood prior to air ambulance arrival
So in my mind, that excluded referring hospital blood products - but you are right - those hospitals might have given blood after helicopter arrival. That is probably it

No benefit from whole blood – the SWiFT trial At this point, most people in the emergency medicine and critical care worlds just assume that balanced (ie, 1:1:1) transfusion is a proven intervention, and the focus has mostly moved on the the potential of whole blood. I am in an almost nonexistent minority when I argue that balanced transfusion is certainly not proven, and may even turn out to be harmful, but that is what the data seems to say.

The first RCT looking at whole blood in trauma is out - and unsurprisingly, there is no benefit
#FOAMed

Research Roundup – March 2026 Classic medicine: running high cost RCTs that are too small to give real answers Préterre C, Gaultier A, Obadia M, Vignal C, Mourand I, Plat J, Sablot D, Gaudron M, Rodier G, Godeneche G, Urbanczyk C, Marc G, Massardier E, Adam S, Boulanger M, Marcel S, Mechtouff L, Ronzière T, Calvière L, Godard-Ducceschi S, Barbin L, Lebranchu P, Guillon B; THEIA collaborators.

Another collection of interesting emergency medicine articles #FOAMed

EMCrit 420 - CV-EMCrit - Nuanced Presentations of Dynamic Left Ventricular Outflow Tract Obstruction (LVOTO): When It’s a “Two-Ventricle” Problem — and So Much More Have you diagnosed dLVOTO in the past 3 months? If not, then you missed it!

I found it a few hours after my post went live, but if you really want to learn about Dynamic Left Ventricular Outflow Tract Obstruction I might skip my post and listen to the experts talking on EMCrit: emcrit.org/emcrit/dlvoto/

One point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working:
Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number!
#emimcc #cccsky

Dynamic left ventricular outflow tract obstruction Dynamic left ventricular outflow tract obstruction (LVOTO) is not a condition I learned about during residency, and it is not a condition I have diagnosed regularly, although I have probably missed it many many times. On First10EM, I usually prefer to start with a presenting symptom than a diagnosis, because that is how patients present. In fact, that is exactly how I started with LVOTO - in…

Dynamic left ventricular outflow tract obstruction
A diagnosis I have certainly missed in my career - what about you? #FOAMed

Norepinephrine isn’t work – now what?? (Management of refractory shock) Most resuscitation is pretty straightforward. No matter how sick the patient is, we select from a fairly limited list of interventions. Hypoxia: does the patient need facemask oxygen, highflow, BiPAP, or intubation? Hypotension: fluids, blood, vasopressors? This basic, well used menu serves us incredibly well for the vast majority of resuscitation. It is simple, which helps manage stress in inherently high stress situations.

Norepinephrine isn't work - now what??
A #FOAMed guide to the assessment and management of refractory shock

Don’t get BiTEn by bispecific T-cell engagers After more than a decade on the job, it feels like I should have this emergency medicine thing figured out, but that just doesn’t seem to be how things work. There are constantly new presentations; patients that provoke new questions. However, I find it incredibly disconcerting when something is time sensitive and life threatening - the central area of my expertise - and I have literally never heard of it.

Don't get BiTEn by bispecific T-cell engagers

This novel class of oncology drugs has 2 time sensitive, life threatening complications that emergency clinicians must know #FOAMed

Research Roundup – January 2026 The big paper of the month: ketamine vs etomidate for RSI Casey JD, Seitz KP, Driver BE, et al. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2025 Dec 9. doi: 10.1056/NEJMoa2511420. Epub ahead of print. PMID: 41369227 On its face, this is a fairly simple pragmatic RCT comparing etomidate to ketamine as the induction agent in critically ill adults.

Research Roundup – January 2026

The big paper of the month: ketamine vs etomidate for RSI Casey JD, Seitz KP, Driver BE, et al. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. N Engl J Med. 2025 Dec 9. doi: 10.1056/NEJMoa2511420. Epub ahead of print. PMID: 41369227 On its…

Vernakalant: shockingly fast without the shock? There are many different approaches to stable patients with atrial fibrillation who present to the emergency department. Personally, I have leaned towards electrical cardioversion over chemical cardioversion in patients in whom cardioversion is appropriate. In the places I work, it is usually faster and easier to get a patient sedated and electrically cardioverted than to wait for drugs to work. However, that is largely because procainamide (the best current best option) is not actually that effective, and is well known for its adverse effects.

Vernakalant: shockingly fast without the shock?

There are many different approaches to stable patients with atrial fibrillation who present to the emergency department. Personally, I have leaned towards electrical cardioversion over chemical cardioversion in patients in whom cardioversion is…

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 3;378(18):1704-1714. doi: 10.1056/NEJMra1505292. PMID: 29719190 Chewcharat A, Nigwekar SU. Ten tips on how to deal with calciphylaxis patients.

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…

Ketamine versus Etomidate | The RSI trial Some topics just get people excited. The drugs we use during intubation - well, people are going to have an opinion. Etomidate was popular while I trained, but was actually hard to find in the emergency department. Then came worries of adrenal suppression. Was etomidate just changing biochemical outcomes, or was it actually changing patient outcomes? Was etomidate increasing mortality? That debate drove many into the arms of ketamine, but the data has always been questionable.

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 fibrillation? The paper Wong CX, Cheung CC, Montenegro G, Oo HH, Peña IJ, Tang JJ, Tu SJ, Wall G, Dewland TA, Moss JD, Gerstenfeld EP, Tseng ZH, Hsia HH, Lee RJ, Olgin JE, Vedantham V, Scheinman MM, Lee C, Sanders P, Marcus GM.

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/...

Research Roundup – December 2025

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.

BroomeDocs podcast December 2025 YouTube video by First10EM

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)

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)

Thank goodness for noise cancelling headphones and Rage Against the Machine