Broome Docs

Welcome to the first post for 2026. Dr Justin joins me once again for an episode of the Journal Club where we do some deep dives into the recent acute AF literature. We take apart the RSI trial (for those in the Antipodes who don’t have etomidate on the shelf – don’t panic – its a negative trial. And we discuss the relative cuteness of suburban racoons in Canada as captured on mobile phones. As usual the PDFs are available at the links that you can click below – so read these for yourself and discuss widely. 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 If an atrium fibrillates and nobody records it do you still have a stroke? Svendsen JH, Diederichsen SZ, Højberg S, Krieger DW, Graff C, Kronborg C, Olesen MS, Nielsen JB, Holst AG, Brandes A, Haugan KJ, Køber L. Implantable loop recorder detection of atrial fibrillation to prevent stroke (The LOOP Study): a randomised controlled trial. Lancet. 2021 Oct 23;398(10310):1507-1516. doi: 10.1016/S0140-6736(21)01698-6. Epub 2021 Aug 29. Erratum in: Lancet. 2021 Oct 23;398(10310):1486. doi: 10.1016/S0140-6736(21)02090-0. PMID: 34469766 When I develop atrial fibrillation, can I still have my 8 cups of coffee a day? 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. Caffeinated Coffee Consumption or Abstinence to Reduce Atrial Fibrillation: The DECAF Randomized Clinical Trial. JAMA. 2025 Nov 9:e2521056. doi: 10.1001/jama.2025.21056. Epub ahead of print. PMID: 41206802 What the heck is vernakalant? Stiell IG, Taljaard M, Eagles D, Yadav K, Vadeboncoeur A, Hohl CM, Archambault PM, Birnie D, Brown E, Campbell SG, Chen Y, Clement CM, Cournoyer A, de Wit K, Emond M, Macle L, McRae AD, Mercier E, Morris J, Mohamad G, Nemnom MJ, Nicholls SG, Pare D, Parkash R, Sivilotti M, Thavorn K, Perry JJ. Vernakalant versus procainamide for rapid cardioversion of patients with acute atrial fibrillation (RAFF4): randomised clinical trial. BMJ. 2025 Nov 11;391:e085632. doi: 10.1136/bmj-2025-085632. PMID: 41218981 Emotional Analgesia and the Decline of Rational Decision Making Stewart D. Emotional Analgesia and the Decline of Rational Decision Making in Emergency Medicine. Emerg Med Australas. 2025 Dec;37(6):e70180. doi: 10.1111/1742-6723.70180. PMID: 41305908 Healthcare systems everywhere are failing their patients Trainee Emergency Research Network (TERN). Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross-sectional snapshot study. Emerg Med J. 2025 Dec 27:emermed-2025-215301. doi: 10.1136/emermed-2025-215301. Epub ahead of print. PMID: 41365687 “Expired” or “best before”? Charlton N, Berry DC, Kannan V, Yee R, Carlson JN, Orkin AM. The use of expired resuscitation medications for life-threatening first aid conditions: a systematic search and narrative review. Resusc Plus. 2025 Sep 23;26:101110. doi: 10.1016/j.resplu.2025.101110. PMID: 41142213 Is it time for doctors to write “dying certificates”? Brindley PG, Morgan M. Diagnosing dying: is it time for doctors to write “dying certificates”? BMJ. 2024 Jun 4;385:q1167. doi: 10.1136/bmj.q1167. PMID: 38834200 The monthly ‘what is Justin smoking’ paper Apostolov A, Bradley A, Dreher S, Dwyer C, Edwards J, Evans ME, Gu N, Hansen J, Lewis JD, Mashburn AT, Miller K, Richardson E, Roller W, Stark A, Swift J, Zuniga O, Lesch R. Tracking domestication signals across populations of North American raccoons (Procyon lotor) via citizen science-driven image repositories. Front Zool. 2025 Oct 2;22(1):28. doi: 10.1186/s12983-025-00583-1. PMID: 41039604

Welcome back tot he final edition of the podcast for 2025. Another collection of big paers, long rants and of course – flying rhinoceros physiology. Its all FOAMed goodness. Stop using steroids to pretreat contrast allergies!! (The radiologists said so) Byrne A, Macdonald DB, Kirkpatrick IDC, Pham M, Green CR, Copaescu AM, McInnes MDF, Ling L, Ellis A, Costa AF. CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity. Can Assoc Radiol J. 2025 Aug;76(3):400-416. doi: 10.1177/08465371241311253. Epub 2025 Jan 11. PMID: 39797723 Basically: DO NOT use steroids to “pre-treat” patients with IV contrast allergies. Keep calm and carry on to CT… A longer write up can be found here. Can we fix CVA with simple supine positioning? Alexandrov AW, Shearin AJ, Mandava P, Torrealba-Acosta G, Elangovan C, Krishnaiah B, Nearing K, Robinson E, Guthrie-Chu C, Holzmann M, Fill B, Trivedi DR, Richardson A, Middleton S, Brewer BB, Liebeskind DS, Goyal N, Grotta JC, Alexandrov AV; ZODIAC Investigators. Optimal Head-of-Bed Positioning Before Thrombectomy in Large Vessel Occlusion Stroke: A Randomized Clinical Trial. JAMA Neurol. 2025 Sep 1;82(9):905-914. doi: 10.1001/jamaneurol.2025.2253. PMID: 40465238 Summary: HEADS DOWN! – if you have a patient in the ED awaiting EV thrombectomy for large vessel CVA the nursing them on a flat (0 degrees) bed may be the best option compared to 30 degrees up which every other patient should probably be at. Are we sucking the life out of patients? Strayer RJ, Oliver M, Chen A, Gerges L, Caputo ND. The Impact of Suctioning on Oxygenation During Rapid Sequence Intubation in the Emergency Department: A Multi-Center Pilot Randomized Controlled Trial. J Emerg Med. 2025 Sep;76:88-94. doi: 10.1016/j.jemermed.2025.04.016. Epub 2025 May 22. PMID: 40533376 Summary: there is no evidence that continuous suction during RSI will do your patient harm or make them hypoxic… so suck away. Personalised Sepsis Resus: ANDROMEDA-SHOCK-2 ANDROMEDA-SHOCK-2 Investigators for the ANDROMEDA Research Network, Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), and Latin American Intensive Care Network (LIVEN); Hernandez G, Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial. JAMA. 2025 Oct 29:e2520402. doi: 10.1001/jama.2025.20402. Epub ahead of print. PMID: 41159835 Summary: doing “personalised” resuscitation for septic patients is what we should probably be doing for our sick patients. This trial showed one way to do this using capillary refill as a target. A longer, more detailed write up of this paper can be found here.  No value from art lines? Muller G, Contou D, Ehrmann S, Martin M, Andreu P, Kamel T, Boissier F, Azais MA, Monnier A, Vimeux S, Chenal A, Nay MA, Salmon Gandonnière C, Lascarrou JB, Roudaut JB, Plantefève G, Giraudeau B, Lakhal K, Tavernier E, Boulain T; CRICS-TRIGGERSEP F-CRIN Network and the EVERDAC Trial Group.. Deferring Arterial Catheterization in Critically Ill Patients with Shock. N Engl J Med. 2025 Oct 29. doi: 10.1056/NEJMoa2502136. Epub ahead of print. PMID: 41159885 Summary: Arterial lines do not save lives. This trial had some super sick, septic patients and there was no overall benefit from art lines over NIBP cuffs…. but there are harms and benefits to both, so think about your practice and what works.. Don’t be a fool, wrap your tool Rippey J, Morris F, Moseley C, Sowerby J, Chiverton L, Mason J. Post-Procedure Perforation Rates in Ultrasound Transducer Covers Used for Ultrasound-Guided Percutaneous Procedures in Emergency Medicine: A Comparison Between Polyurethane Covers and Polyethylene Covers. Australas J Ultrasound Med. 2025 Sep 25;28(4):e70025. doi: 10.1002/ajum.70025. PMID: 41017784 Summary: Ultrasound probe covers leak. You should not trust the last person who used the probe and assume it is dirty before you do a sterile procedure. Clean the probe properly yourself! Older patients fall, can we predict who will need interventions? Not on this data. Dubucs X, Gingras V, Boucher V, Carmichael PH, Ruel M, De Wit K, Grewal K, Mercier É, Blanchard PG, Benhamed A, Charpentier S, Émond M. Risk Factors for Traumatic Intracranial Hemorrhage in Older Adults Sustaining a Head Injury in Ground-Level Falls: A Systematic Review and Meta-analysis. Ann Emerg Med. 2025 Jul 22:S0196-0644(25)00313-0. doi: 10.1016/j.annemergmed.2025.05.021. Epub ahead of print. PMID: 40699169 Summary:  Biased data sets can result in weird conclusions that need further thought. Don’t believe the hype, DOACS do not protect your brain if you fall over! Uncertainty in medical training Ilgen JS, Dhaliwal G. Educational Strategies to Prepare Trainees for Clinical Uncertainty. N Engl J Med. 2025 Oct 23;393(16):1624-1632. doi: 10.1056/NEJMra2408797. PMID: 41124633 “Uncertainty is ubiquitous in medical practice. If there was no uncertainty, society would not need physicians to render judgments.” Summary: We should routinely train doctors to deal with uncertain situations – the rest is pretty simple. Can emergency medicine be saved? Atkinson P, Lang E. Can emergency medicine be saved? CJEM. 2025 Oct;27(10):760-763. doi: 10.1007/s43678-025-01034-w. Epub 2025 Oct 18. PMID: 41108498 Summary: An editorial that is worth a read. Big picture thinking about what Emergency Medicine is and should be. Did you ever wonder how to measure oxygenation in a flying sedated rhinoceros? Radcliffe RW, Jago M, Morkel PV, Morkel E, du Preez P, Beytell P, Kotting B, Manuel B, du Preez JH, Miller MA, Felippe J, Parry SA, Gleed RD. THE PULMONARY AND METABOLIC EFFECTS OF SUSPENSION BY THE FEET COMPARED WITH LATERAL RECUMBENCY IN IMMOBILIZED BLACK RHINOCEROSES (DICEROS BICORNIS) CAPTURED BY AERIAL DARTING. J Wildl Dis. 2021 Apr 1;57(2):357-367. doi: 10.7589/2019-08-202. PMID: 33822147 Summary: You just need to look at this picture to appreciate how easy your job is!

The latest podcast with Dr. Justin Morgenstern. We look at all the latest evidence and a few older pieces from the world of Emergency care. This month we tackle: AI bots for OMIs, paracentesis plumbing, antiplatelet pharma, facial fractures and a sublingual anaphylaxis agent!  Its a lot!  #FOAMed Physicians vs Queen of Hearts AI Bot 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. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Jul 30;97:193-199. doi: 10.1016/j.ajem.2025.07.061. Epub ahead of print. PMID: 40763602 Saving toes, thawing digits: sous vide to the rescue? Daniel NJ, Storn JM, Weinberg NE, Galvin WA, Irons HR, Barksdale AN, Rischall ML, Bilodeau SM, Gale JY, Willet KG, Wilson A, Keiper K, Chevalier J. Assessment of sous vide water baths in the acute rewarming of frostbitten extremities: A multicenter study. Acad Emerg Med. 2025 May;32(5):574-577. doi: 10.1111/acem.15061.PMID: 39654121 Paracentesis Plumbing Practice Konerman MA, Price J, Torres D, Li Z. Randomized, controlled pilot study comparing large-volume paracentesis using wall suction and traditional glass vacuum bottle methods. Therap Adv Gastroenterol. 2014 Sep;7(5):184-92. doi: 10.1177/1756283X14532704. PMID: 25177365  This post from Maimonides goes into a little more detail.  Ticagrelor vs Clopidogrel… and the winner is… Kutcher SA, Dendu kuri N, Dandona S, Nadeau L, Brophy JM. Ticagrelor Compared to Clopidogrel in Acute Coronary Syndromes trial (TC4): a Bayesian pragmatic cluster randomized controlled trial. CMAJ. 2025 Mar 30;197(12):E309-E318. doi: 10.1503/cmaj.241862. PMID: 40164463 Trigger point injections: once a fad, now just bad? Lajeunesse MD, Olivera TR, April MD, Benesch HA, Castaneda P, Couperus KS, Dang VN, Park MS, Deboer RS, Dougherty CA, Downing NC, Gray MW, Hull AM, Jimenez BL, Klausner MJ, Sakai JHM, McLean TJ, Nepal N, Patten HW, Schwartz BT, Walther ND, Wolterstorff CS, Oliver JJ. Trigger Point Injection for Myofascial Pain Syndrome of the Low Back: A Partially Blinded Three-Arm Randomized Controlled Trial. Ann Emerg Med. 2025 Jun 17:S0196-0644(25)00298-7. doi: 10.1016/j.annemergmed.2025.05.008. PMID: 40531073 Anti-amyloid agents for Alzheimers – what we need to know Rech MA, Carpenter CR, Aggarwal NT, Hwang U. Anti-Amyloid Therapies for Alzheimer’s Disease and Amyloid-Related Imaging Abnormalities: Implications for the Emergency Medicine Clinician. Ann Emerg Med. 2025 Jun;85(6):526-536. doi: 10.1016/j.annemergmed.2024.12.002. Epub 2025 Jan 17. PMID: 39818674 More details here. Facial Fracture Referrals – Castillo Diaz F, Anand T, Khurshid MH, Kunac A, Al Ma’ani M, Colosimo C, Hejazi O, Ditillo M, Magnotti LJ, Joseph B. Look me in the face and tell me that I needed to be transferred: Defining the criteria for transferring patients with isolated facial injuries. J Trauma Acute Care Surg. 2025 May 9. doi: 10.1097/TA.0000000000004651. Epub ahead of print. PMID: 40341445 An oral anaphylxis agent… on the horizon Kraus CN, Wargacki S, Golden D, Lieberman J, Greenhawt M, Camargo CA Jr. Integrated phase I pharmacokinetics and pharmacodynamics of epinephrine administered through sublingual film, autoinjector, or manual injection. Ann Allergy Asthma Immunol. 2025 May;134(5):580-586. doi: 10.1016/j.anai.2025.01.006. Epub 2025 Jan 16. PMID: 39826899