First10EM Journal Club: December 2025

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!

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