CJEM

Young woman + chest pain + no risk factors? Think SCAD. 🩺🫀 The latest @CJEMonline Just the Facts breaks down Spontaneous Coronary Artery Dissection: ✅ 35 percent of MIs in women 50 or younger are due to SCAD. ✅ Postpartum patients (especially first 12 weeks) are at high risk. ✅ ECG within 10m: STEMI is common, but a normal ECG doesn't rule it out. ✅ Conservative management is generally preferred once diagnosed. Don't miss this insidious diagnosis just because the patient doesn't fit the "classic" MI profile. Early recognition is key to a favorable prognosis. 🔗 Article Link: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #Cardiology #SCAD #CJEM #FOAMed

Commentary: When less is more - reducing antibiotic overuse in immunocompetent children with febrile neutropenia @NaveenPoonai link.springer.com/article/10.100…

Are we over-treating healthy kids with febrile neutropenia? 🤒🩺 A new @CJEMonline QI study shows how aligning with 2023 CPS guidelines safely reduces antibiotic overuse: ✅ Non-indicated antibiotics dropped from 6.7% to 1.6%. ✅ 97 consecutive cases managed without error. ✅ Zero missed serious bacterial infections. ✅ No increase in ED re-presentations. The bottom line: Well-appearing, immunocompetent children can often avoid antibiotics and admission with close follow-up. De-implementing low-value care benefits families and the health system alike. 🔗 Read the full article: link.springer.com/article/10.100… #MedTwitter #PedsEM #AntibioticStewardship #EmergencyMedicine #CJEM #QI Infographic by @NotebookLM

🧵1/5 Education is a key lever for equity. 🧑‍🏫 Simulation-based training can improve inclusive care. Now in @CJEMonline: Our multi-modal 2SLGBTQIA+ health and cultural humility curriculum significantly boosted EM residents' clinical preparedness, attitudes & knowledge in caring for 2SLGBTQIA+ patients. Full paper (open access): doi.org/10.1007/s43678… #MedEd #HealthEquity

Normal glucose does NOT rule out DKA. 🩺🩹 The latest CJEM "Just the Facts" breaks down euglycemic DKA associated with SGLT-2 inhibitors (SGLT-2-i). ✅ Glucose can be normal or only mildly elevated, which often delays diagnosis. ✅ Prevalence is ~6.6% of DKA admissions in a Canadian study. ✅ Management: Start IV insulin AND 5% dextrose concurrently to prevent hypoglycemia. Be alert for tachypnea or malaise in patients on SGLT-2-i, even if their bedside glucose looks fine. 🔗 Article Link: link.springer.com/article/10.100… #EmergencyMedicine #FOAMed #MedTwitter #Diabetes #CJEM #MedEd

AI-assisted translation for discharge instructions - building a Tower of Babel or a solution for our patients #ArtificialIntelligence is taking over, including formal translation. We have some thoughts on this. Would love to hear yours! Free Article: link.springer.com/article/10.100…

⭐️April Issue⭐️ Link: link.springer.com/journal/43678/… 📜Just the Facts: SGLT2 Inhibitor induced DKA work-related MSK injuries SCAD pediatric viral exanthems 📑Original Research: Two- vs three-hour hs-cTnI algorithms ChatGPT-guided translation of pediatric ED discharge instructions Predictors of bounce back for children redirected by triage - peds Staff perspectives on the impacts of the COVID-19 pandemic on the provision of emergency department care for patients who use opioids ☑️#QIPS Reducing antibiotic overuse in immunocompetent children with febrile neutropenia in a pediatric ED and more...

The "dark room" is out, active recovery is in! 🧠🧒 Check out the latest @CJEMonline "Just the Facts" on Pediatric Concussion for the newest evidence-based guidelines: ✅ New ACRM Criteria: Symptoms must manifest within 72 hours of injury. ✅ Risk Score: Use the 5P Score: if ≥ 4, refer to an interdisciplinary team early. ✅ No More Strict Rest: Initiate light aerobic activity and social interaction after 24–48 hours. ✅ Back to Class: Return to school within 1–2 days; avoid absences > 1 week. Don't let patients "rest" their way to a longer recovery. Early, gradual activity is the key to faster healing. 📈🏃‍♂️ 🔗 Full article: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #Pediatrics #FOAMed #Concussion #CJEM

Can redirecting low-acuity patients at triage help unblock our EDs? 🏥🔄 A new pan-Canadian survey in @CJEMonline (N=719) reveals: ✅ 88.7% of ED staff believe redirection to clinics is safe. ✅ 86.9% agree it will decrease wait times for ambulatory patients. ✅ 76.8% believe it reduces "left without being seen" rates. The Challenges: ❌ 87.2% say insufficient clinic hours are the #1 barrier. ❌ 63.8% say triage nurses don't have enough time for safe redirection. While Québec leads in adoption (96.7%), support varies across provinces. Is it time for a national standard for redirection? 🇨🇦 🔗 Read more: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #HealthSystems #CJEM #FOAMed #Nursing Infographic by @NotebookLM

10% of patients are labeled with a penicillin allergy, but <1% are truly allergic. Are we avoiding first-line treatments unnecessarily? 💊🤔 The latest @CJEMonline "Just the Facts" breaks down ED penicillin delabeling: ✅ Use the PEN-FAST rule: A score <3 identifies low-risk patients. ✅ Direct oral challenge: Amoxicillin 500mg in the ED is safe for low-risk patients. ✅ 30-60 min observation: If no symptoms occur, remove the label! ✅ Cross-reactivity: Carbapenems are safe for ALL, even those with anaphylaxis. Stop the "allergy" label from compromising patient care. Better stewardship starts in the ED. 🛡️🚑 🔗 Full open access article: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #FOAMed #AntibioticStewardship #CJEM #MedEd

March Issue now online: link.springer.com/journal/43678/… Just the Facts: ⭐️Management of AECOPD ⭐️Penicillin Allergy ⭐️Dx of Pediatric Concussion ⭐️Management of Febrile Infants 60 Days Old and Younger Original Research: 📑Evaluating the quality of Canadian pediatric sepsis clinical practice guidelines 📑Pediatric addictions and mental health boarding in emergency departments 📑VRR-CPD: adapting free and open-access distance simulation for the continuing interprofessional education 📑Perceptions and attitudes of ED physicians, nurses and managers regarding the redirection of low-acuity patients. And more... #CJEM #emergencymedicine #pediatrics #penicillin #copd #concussion

Intractable vomiting + relief with hot showers? 🚿🤢 It’s time to talk about Cannabinoid Hyperemesis Syndrome (CHS). What you need to know: ✅ 1 in 200 frequent cannabis users are affected. ✅ Haloperidol (0.05 mg/kg IV) is more effective than traditional antiemetics. ✅ Topical capsaicin and hot water are high-yield symptomatic adjuncts. ✅ Cessation is the only definitive cure. ✅ Don't rely on ondansetron - it often fails in these cases. 🔗 Full open access article: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #CHS #Cannabis #FOAMed #CJEM #Toxicology

"We praise the nurse who skipped breaks, the physician who stayed late, and the team that “made it work” despite impossible conditions. [...] repeated heroics signal design failure. The question is not who saved the day, but why saving was required at all." An important read.

Is your ED a "gateway to care" or a "holding area for a stalled system"? A new commentary in @CJEMonline by @PaulAtkinsonEM and colleagues examines the normalization of breakdown in Canadian healthcare. ❌ "Demand" is a fallacy: The crisis is driven by immobility, not arrival. Patients can't move to inpatient "stolen beds". ❌ Heroism = Design Failure: Relying on clinicians to "make it work" masks deep systemic flaws. ✅ Safety Infrastructure: We must reframe empty beds as essential resilience, not "wasteful" slack. The Solution: Enforceable national access standards to ensure ED failure is no longer treated as an unavoidable emergency medicine problem. 🛡️🏥 🔗 Full Commentary: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #FOAMed #HealthPolicy #CJEM #PatientSafety cc: @picardonhealth

Managing Immune Thrombocytopenic Purpura (ITP) in the ED? 🩸🔬 The latest @CJEMonline "Just the Facts" provides a high-yield roadmap: ✅ Diagnosis: Isolated thrombocytopenia (<100 × 10⁹/L). Always check a peripheral smear to rule out schistocytes or clumping! ✅ Treatment: If platelets are <30 × 10⁹/L, start corticosteroids. Add IVIG if active bleeding is present. ✅ Steroid Choice: Dexamethasone (40mg x 4 days) offers faster improvement than prednisone. 🚫 Avoid: NSAIDs (except celecoxib) and antiplatelets. Stable patients without bleeding can often be discharged with urgent hematology follow-up. 🔗 Full Open Access article: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #Hematology #ITP #FOAMed #CJEM

Does biological sex predict 1-year outcomes for ED patients with alcohol withdrawal? 🚑🧪 A new @CJEMonline multicenter study (N=1,019) by Frank Scheuermeyer et al. finds that while index clinical severity (CIWA-Ar) and ED treatments are similar, outcomes diverge significantly post-discharge: 📊 Mortality: 2.6% (M) vs. 0.4% (F) at 1 year. 📊 7-Day Reattendance: 21.2% (M) vs. 12.8% (F). 📊 Frequent Users: Males in the highest decile averaged 31.2 visits/yr vs. 20.7 for females. Conclusion: Males demonstrate a higher risk for recidivism and mortality. Clinicians should consider sex-specific management and early activation of social supports for high-utilization cohorts. 🔗 Open Access link: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #AddictionMedicine #CJEM Infographic by @NotebookLM @EMO_Daddy @PaulAtkinsonEM @EddyLang1 @CAEP_Docs @CAEPResidents @ClinMedJournals

Mortality for cardiogenic shock is still >40%. Are you using the latest staging & management strategies? 🫀🚑 The new @CJEMonline "Just the Facts: approach to cardiogenic shock in the ED" breaks it down: ✅ Use SCAI Staging (A-E) to predict risk & mortality. ✅ PoCUS is key: check biventricular function & rule out tamponade. ✅ Norepinephrine is your 1st-line vasopressor. ✅ Consult cardiology early for revascularization. 🚫 Clinical Tip: Avoid beta-blockers & CCBs in acute tachyarrhythmias if LV function is uncertain. Read the full Open Access article: 🔗 link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #FOAMed #CardiogenicShock #CJEM

“A patient waits for hours in an emergency department… and dies before being assessed.” Not rare. Not random. ED crowding is the visible end of hidden system failure. New CJEM commentary: How health systems learn to fail. link.springer.com/article/10.100…

Are you maximizing the role of pharmacists in your ED? 💊🏥 A new multicenter review in @CJEMonline by Ivy Nhan et al. shows the massive impact of pharmacist-led culture follow-up programs: ✅ Pharmacists intervened in 40.7% of cultures reviewed. ✅ Top interventions: Initiating therapy (33%) and tailoring treatment (22%). ✅ Key for Antimicrobial Stewardship (AMS) in high-turnover ED settings., In Alberta, independent prescribing authority allows pharmacists to streamline care and reduce physician workload., Broader adoption of these programs = better patient outcomes and less antibiotic resistance. 🛡️🦠 🔗 Full article here: link.springer.com/article/10.100… #MedTwitter #EmergencyMedicine #AntibioticStewardship #Pharmacy #FOAMed #CJEM Infographic by @NotebookLM

February 2026 Issue now available: link.springer.com/journal/43678/… ⭐️Just the Facts: Drug-induced seizures, Cardiogenic shock, ITP and Cannabinoid Hyperemesis ⭐️Antimicrobial Stewardship in the ED by Ivy Nhan ⭐️Acute code stroke activations seen in the ED by Emily Li ⭐️Sex differences in the 1-year outcomes of emergency department patients with alcohol withdrawal by Frank Scheuermeyer With one Open Access article available: link.springer.com/article/10.100…