First10EM Journal Club: January 2026

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.

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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

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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

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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

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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

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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

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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

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“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

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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

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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

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