YBEMUS Newsletter · April 2026

01

This Month in Emergency Medicine

The future of EM documentation may be listening to your patients — and we finally have the data to prove it. Taming the SRU dropped a timely journal club analyzing real-world EHR audit logs from EDs where attending physicians had optional access to ambient AI scribes. The findings are nuanced: adoption patterns varied significantly by physician and care zone, and the tool performed differently across patient acuity levels and interpreter-required encounters. The SGEM tackled geriatric delirium with fresh GRADE-based clinical practice guidelines from Academic Emergency Medicine, covering risk stratification, screening tools, and the perennial "when do I scan this patient's head?" question — guidance long overdue given how often delirium masquerades as everything else in the over-75 crowd. St.Emlyn's offered a timely systems-thinking rebuke of the healthcare culture of reflexive module-creation after adverse events, and EMCrit served a blunt reality check: "You don't understand dizziness and vertigo — but you need to." Harsh. Accurate. Bookmarked.

Pulmonary embolism had a very busy month, and your management algorithm may need an update. Four major trials converged: HI-PEITHO showed ultrasound-assisted catheter thrombolysis reduces haemodynamic deterioration versus heparin alone with an NNT of 16 — but crucially, no mortality benefit. PEERLESS found large-bore mechanical thrombectomy (FlowTriever) roughly equivalent to catheter-directed thrombolysis in intermediate-risk PE, with less ICU time but similar mortality and bleeding. STRATIFY randomised intermediate-high-risk patients to heparin, USAT, or systemic alteplase — and STORM-PE compared mechanical thrombectomy to anticoagulation alone. First10EM captured the meta-lesson: peripheral thrombolytic administration may be just as effective as catheter-directed delivery, raising real questions about cost-complexity-benefit ratio. The 2026 AHA PE Guidelines have also landed — read Broome Docs' breakdown for a synthesis of all four trials in one place.

On the advocacy front, the month was sobering. ACEP and EMRA joined over 20 medical societies calling for a national-interest exemption for physicians after the detention of Dr. Rubeliz Bolivar — an EM resident with valid U.S. work authorization — reframing workforce vulnerability in stark terms. The record Match Day 2026 results (3,058 positions filled, 95.6% fill rate, all-time high) provided welcome contrast, suggesting the specialty's pandemic-era reputation wounds are healing. Utah's House Bill 350 — requiring hospitals to build formal violence reporting systems and anti-retaliation policies — takes effect November 2026. ICEM/IFEM 2026 heads to Hamburg; St.Emlyn's has the preview if you're planning the trip.

02

Why It Matters — 3 Points

Point 01

POCUS in Cardiac Arrest — Faster and More Accurate Than Your Fingertips

A new evidence update in the American Journal of Emergency Medicine formally concludes that POCUS determines pulse presence or absence faster and more accurately than manual palpation during cardiac arrest. Applications include tamponade, RV dilation, occult V-fib, ETT confirmation, pneumothorax, and compression optimization. Paired with ACEP's February guidance on AI-assisted POCUS devices — mostly radiology-focused today, but EM authorization accelerating — the argument for a formal departmental cardiac arrest POCUS protocol is now essentially bulletproof.

Point 02

Ambient AI Scribes — The Real Story Is Who Doesn't Use Them

The Taming the SRU journal club highlights what the vendor demos don't tell you: adoption in the ED isn't uniform. Physicians in high-acuity zones, interpreter-required encounters, and resuscitation bays used ambient AI scribes differently or not at all. The documentation burden is highest exactly where these tools perform least predictably. Before a departmental rollout, demand the audit log data — not the sales deck.

Point 03

PE Management — Four Trials, One Lesson

Between HI-PEITHO, PEERLESS, STRATIFY, and STORM-PE, we now have more RCT data on intermediate- and high-risk PE management than in the preceding decade combined. The collective signal: catheter-based interventions reduce some downstream complications but have not demonstrated a mortality benefit over systemic thrombolysis, and peripheral administration may match catheter-directed delivery in many scenarios. The 2026 AHA Guidelines synthesize this into actionable risk stratification. Before you call IR at 2am, know your PESI, your troponin, and your echo.

03

From Your FOAMed Feeds

Source	Story	One-Liner
REBEL EM	Preoxygenation Meta-Analysis 15 studies, n=3,420	HFNC, NIPPV, or facemask — the answer is more nuanced than your RSI checklist assumes.
emDocs	EBM Acute Appendicitis Pt. 1	WSES: use clinical scores to exclude appy and identify intermediate-risk patients — not to confirm. Alvarado lacks specificity.
SGEM #507	Geriatric ED Delirium GRADE Guidelines	Risk stratification, screening, and neuroimaging framework for suspected delirium in older patients.
ECG Interpretation	ECG Blog #526: Epigastric Pain & deWinter T Waves	Overly tall peaked anterior T waves + abdominal pain = deWinter-like pattern until proven otherwise. Cardiology said "repolarization variant." It wasn't.
The Trauma Pro	Massive Transfusion Cooler Etiquette	Clear signage + blood bank communication protocol when MTP activates and ends.
Don't Forget the Bubbles	Eczema Coxsackium	HFMD variant with severe cutaneous involvement in eczematous children — know it before it walks in.
PEMBlog	Croup Podcast	Severity assessment, universal corticosteroids, selective epi — plus the airway mimics that will ruin your shift.
EMCrit	Dizziness & Vertigo Wee	"You Don't Understand Dizziness and Vertigo — But You Need To." Go listen.

04

POCUS Corner 🔬

Forearm nerve blocks for acute hand ischemia EP-performed, ultrasound-guided nerve blocks — POCUS Journal, Gawel et al.
Esophageal & gastric foreign body detection POCUS across stable and unstable patients; enhanced outcomes — Lamour et al.
Pregnancy evaluation with handheld non-piezoelectric devices IUP confirmed at low hCG; consistent fetal heart motion detection — Yun & Wubben.
Diaphragmatic ultrasound in pediatric respiratory assessment Predicts outcomes beyond traditional clinical scoring.
AI in POCUS billing & reimbursement ACEP Ultrasound Section primer on FDA-authorized AI imaging tools. Read it before your next committee meeting.
POCUS in cardiac arrest Faster and more accurate pulse detection than manual palpation; maps to tamponade, RV dilation, V-fib, ETT, pneumothorax — Am J Emerg Med.

05

Closing Questions

Q1

AI Scribes & Workflow

The ambient scribe data shows uneven adoption across care zones. Where in your department would an AI scribe realistically help — and where would it be a liability?

Q2

PE Management

Four PE trials in one month, no mortality benefit for catheter-directed therapy over systemic thrombolytics. What's your current threshold for calling IR, and has this evidence shifted it?

Q3

ECG Interpretation

Cardiology called it a repolarization variant; the EP suspected deWinter. How does your department handle consultant disagreement on high-stakes ECG interpretation in real time?

Q4

Workforce & Retention

Match Day 2026 is a record — but what does retention look like at year 3? What's one structural change that would make EM a 30-year career instead of a 10-year sprint?