Curated weekly emergency medicine evidence for CCEMRP residents and BCM/CHRISTUS Children's PEM fellows. High-yield summaries with clinical bottom lines. PEM adaptations flagged 🟣.
Mechanical CPR devices (LUCAS, AutoPulse) are increasingly deployed in OHCA — in part because they allow hands-free compressions during intra-arrest transport. Whether this logistical advantage translates into better neurological outcomes compared to high-quality manual CPR during transport has not been clearly established.
A multicenter observational study examined neurological outcomes at hospital discharge comparing mechanical vs. manual CPR in OHCA patients undergoing intra-arrest transport. Mechanical devices did not confer a neurological survival advantage — quality of compressions during transport remains the key variable regardless of device use.
Mechanical CPR may facilitate transport logistics, but neurological benefit over high-quality manual CPR during intra-arrest transport remains unproven. Don't let device use substitute for compression quality monitoring.
ECPR is increasingly available at capable centers, but the optimal timing remains unresolved: should ECMO be initiated upfront (emergency ECLS strategy) or held as a rescue after standard ACLS failure? This protocol paper outlines an upcoming RCT designed to answer this question directly.
The ECLS-OHCA trial will randomize refractory OHCA patients to upfront emergency ECLS deployment vs. standard ACLS with selective rescue ECMO. This trial will shape future resuscitation algorithms and define institutional ECMO activation criteria.
Know the trial landscape. Familiarity with ECPR candidate selection criteria prepares you for discussions with cath lab and cardiac surgery colleagues about institutional ECMO protocols — even before results are published.
Current ECPR candidate criteria at most centers: witnessed arrest, shockable rhythm, CPR ≤ 60 min, age < 70, no obvious futility. Internalize these — you may be the one making the call.
The survival benefit of prehospital RSI in trauma has been debated for decades. Simple comparisons are confounded by patient severity — the sickest patients may die despite (or because of) intubation. Causal modelling methods applied to large prehospital datasets can better isolate the treatment effect.
Using causal modelling on a large prehospital trauma dataset, prehospital emergency anaesthesia with intubation was associated with a meaningful survival benefit in appropriately risk-stratified patients — particularly severe TBI and hemodynamic instability meeting pre-specified criteria. The benefit was attenuated or reversed in lower-acuity patients, underscoring that patient selection drives outcomes.
Prehospital RSI isn't one-size-fits-all. Risk stratification matters — the sickest patients benefit most. Know your RSI pharmacology cold and understand the physiologic risks of peri-intubation hemodynamic collapse in trauma.
Damage-control physiology before the tube: push blood/fluid before RSI in hypotensive trauma patients. Ketamine for induction; mitigate post-intubation hypotension aggressively.
Point-of-care hs-troponin pathways have become standard for chest pain evaluation, but the variables that modify their diagnostic performance — and the gaps between pathway recommendations and actual physician disposition — are incompletely characterized.
Post-hoc analysis of a prior RCT found POC troponin pathways perform best in low-to-intermediate pretest probability patients. High-risk clinical features still require clinical override. Algorithm-physician concordance gaps persist for atypical presentations. Key modifiers reducing discriminatory performance: renal disease, LBBB, early presenters (<2h from symptom onset).
The hs-cTn pathway is a tool, not a replacement for clinical judgment. Apply the Alinity hs-cTnI protocol with awareness of the variables that reduce its performance — renal disease, LBBB, and early presenters all warrant modified interpretation.
In adult OHCA, the "load-and-go" vs. "stay-and-play" debate is well characterized. For pediatric OHCA, the relationship between EMS scene time and survival has been less rigorously studied in large, representative datasets.
Using the National EMS Information System (NEMSIS), longer scene times were independently associated with worse survival and neurological outcomes in pediatric OHCA, even after adjusting for ROSC on scene. The association reinforces a load-and-go philosophy for pediatric arrests in most EMS systems.
For pediatric OHCA: minimize scene time. Start high-quality CPR, establish IV/IO access, and transport. Don't delay transport for prolonged on-scene resuscitation unless ROSC is imminent or special circumstances apply (e.g., traumatic arrest with correctable cause).
Directly relevant to pediatric resuscitation protocols and EMS medical direction curriculum. Pair with your PECARN/PALS didactic series. Consider implications for your local EMS protocol review.
Testicular torsion is a time-critical diagnosis where delays directly reduce salvage rates. The TWIST clinical scoring tool stratifies risk but has limitations in the intermediate range. POCUS can be performed bedside without delaying surgical consultation.
The combination of TWIST + POCUS improved sensitivity for torsion, potentially enabling earlier surgical consultation and reducing time to OR. TWIST ≥ 5 warrants urgent urology regardless of ultrasound findings. POCUS adds meaningful value in the intermediate range (TWIST 2–4).
Time to detorsion is everything. TWIST ≥ 5 = call urology now, don't wait for formal radiology. In the intermediate range, POCUS adds value and is faster than color Doppler imaging. When in doubt, call urology early.
POCUS-integrated diagnostic protocols are a core competency. Add testicular torsion to your POCUS curriculum scanning log targets. Know the TWIST score cold — this is a board favorite.
First afebrile seizures in pediatric patients generate significant diagnostic and disposition uncertainty. Identifying which children are at high risk for developing epilepsy could guide urgency of neurology follow-up and family counseling.
A clinical prediction tool was derived and internally validated to identify children at high risk of epilepsy after a first afebrile seizure. Variables included age, seizure semiology, EEG findings, and neuroimaging. The tool remains in early validation — external validation is required before widespread adoption.
Not all first seizures are equal risk. Use this tool to frame risk communication with families and guide urgency of neurology follow-up — but it doesn't replace clinical judgment or neurology consultation for high-risk features (focal onset, prolonged duration, abnormal exam).
Seizure management and first-seizure workup are bread-and-butter PEM. This study supports evidence-based disposition framing. Pair with your neurology consultation protocols and the AAP first-seizure guideline.
Triage accuracy is a foundational patient safety issue. Both undertriage (too low an acuity assignment) and overtriage (too high) have downstream consequences — but the nature and magnitude of those consequences differ and have not been systematically quantified in a large observational dataset.
Undertriage was more strongly linked to delayed interventions and poor outcomes; overtriage was associated with resource misallocation and downstream crowding. Both error types were independently associated with care disruptions. Triage accuracy matters in both directions, but undertriage is the more dangerous error clinically.
Knowing the triage system is a patient safety issue, not just logistics. Systematically reassess ESI 3–4 patients who are "quiet" — undertriage is the more dangerous error. Build the habit of early reassessment for patients who don't look as expected for their acuity.
Published March 15, 2026. The ALiEM AIR Team curated the top endocrine emergency FOAMed posts — 6 AIR-stamped posts + 5 honorable mentions (~5.5 hrs III credit). Covers: DKA, adrenal crisis, myxedema, thyroid storm, and more. Excellent for self-directed learning or a structured didactic session.
A full month of curated and critically appraised EM + critical care papers. Covers RCTs, prehospital studies, pediatric EM, and operations. Updated March 13, 2026. Excellent companion to this digest for deeper critical appraisal of the same papers.
Comprehensive review from The Big Sick conference covering the most impactful EM papers of the past year — trauma, airway, resuscitation systems, and high-stakes decisions. Includes prehospital and intensive care companion reviews. High-yield synthesis for your annual reading.
Use The Bottom Line's critical appraisal summaries alongside this synopsis to practice EBM skills. ALiEM AIR endocrine module counts toward III credit — log it.