First10EM

Emergency medicine - When minutes matter...

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ARISE FLUIDS – Fluids, pressors, neither, both? 19 Oct 2026
The management of sepsis has evolved dramatically since I was a trainee, just after Manny Rivers published his seminal sepsis protocol. At this point, I think we mostly know what we are doing. We give antibiotics. We look for a source and get source control. We give some fluids,…
Normal saline is not normal and other nonsense that people love to spout (The PRoMPT trial) 12 Oct 2026
Personally, I find the normal saline versus balanced fluid debate pretty boring. I don’t really care which you choose. It seems incredibly unlikely that your choice of crystalloid will have any clinical impact on patients. I use saline, but I don’t really have a strong opinion.…
3 foot falls and other arbitrary cutoffs we use (Oishi 2026) 05 Oct 2026
One reason that clinical judgement regularly beats decision rules is that decision rules (at least as they are currently designed) are forced to use arbitrary cut-offs. Imagine you develop a little bit of pleuritic chest pain during your 50th birthday dinner. Head straight to…
An RCT of heparin in STEMI 28 Sep 2026
The use of heparin in acute coronary syndrome was one of the primary gateways into my hatred of guidelines. Medical guidelines contain a lot of recommendations that aren’t exactly evidence based. When you dig into the evidence for heparin in NSTEMI, it becomes pretty clear that…