Justin Morgenstern
@first10em.bsky.social
Reposted by Justin Morgenstern
would not start antihypertensives.
would discharge home immediately (it doesn’t seem like this admission is even indicated?)
outpatient followup
honestly this guy needs good outpatient management, not a fancy hospitalization that will be super expensive
would discharge home immediately (it doesn’t seem like this admission is even indicated?)
outpatient followup
honestly this guy needs good outpatient management, not a fancy hospitalization that will be super expensive
For a man hospitalized for uncomplicated diverticulitis who is found to have high blood pressure, would you support watchful waiting or recommend inpatient treatment of the high blood pressure? Read the case vignette, treatment options, and vote: nej.md/485a82I
November 25, 2025 at 1:56 PM
would not start antihypertensives.
would discharge home immediately (it doesn’t seem like this admission is even indicated?)
outpatient followup
honestly this guy needs good outpatient management, not a fancy hospitalization that will be super expensive
would discharge home immediately (it doesn’t seem like this admission is even indicated?)
outpatient followup
honestly this guy needs good outpatient management, not a fancy hospitalization that will be super expensive
Reposted by Justin Morgenstern
I predict this will not be enough to convince some people:
285 studies
132 million people in real-world data
157,414 in randomized trials
~80% reduction in cervical cancer when given before age 16
No increase in serious adverse events @drjengunter.bsky.social
www.eurekalert.org/news-release...
285 studies
132 million people in real-world data
157,414 in randomized trials
~80% reduction in cervical cancer when given before age 16
No increase in serious adverse events @drjengunter.bsky.social
www.eurekalert.org/news-release...
New research confirms HPV vaccination prevents cervical cancer
Two new Cochrane reviews show strong and consistent evidence that HPV vaccines are effective in preventing cervical cancer and pre-cancerous changes, especially when given to young people before they ...
www.eurekalert.org
November 25, 2025 at 1:28 PM
I predict this will not be enough to convince some people:
285 studies
132 million people in real-world data
157,414 in randomized trials
~80% reduction in cervical cancer when given before age 16
No increase in serious adverse events @drjengunter.bsky.social
www.eurekalert.org/news-release...
285 studies
132 million people in real-world data
157,414 in randomized trials
~80% reduction in cervical cancer when given before age 16
No increase in serious adverse events @drjengunter.bsky.social
www.eurekalert.org/news-release...
Reposted by Justin Morgenstern
“I have been using a combination of cap refill and MAP since the original ANDROMEDA SHOCK paper”
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2) #FOAMed
Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2)
As far as I can tell, despite talking about the paper widely at conferences, I never included a write up of the original ANDROMEDA-SHOCK trial on First10EM. (Hernández 2019) (There is a massive file of all the topics I want to cover, and would cover if this was a job rather than a hobby. I assume it just got lost in there.) As a reminder, that trial showed that clinical management of septic shock patients based on capillary refill time was not statistically different from management guided by trending lactates, although there was some optimism because the point estimate for all cause mortality was actually 9% better.
first10em.com
November 24, 2025 at 2:30 PM
“I have been using a combination of cap refill and MAP since the original ANDROMEDA SHOCK paper”
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
Justin explores the many limitations of this trial but then admits that he does use CRT as a resus target.
I fundamentally agree.
Implementing imperfect data into practice is complicated. #EMIMCC
Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2) #FOAMed
Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2)
As far as I can tell, despite talking about the paper widely at conferences, I never included a write up of the original ANDROMEDA-SHOCK trial on First10EM. (Hernández 2019) (There is a massive file of all the topics I want to cover, and would cover if this was a job rather than a hobby. I assume it just got lost in there.) As a reminder, that trial showed that clinical management of septic shock patients based on capillary refill time was not statistically different from management guided by trending lactates, although there was some optimism because the point estimate for all cause mortality was actually 9% better.
first10em.com
November 24, 2025 at 11:45 AM
Not so fast with the capillary refill guided resuscitation (ANDROMEDA-SHOCK-2) #FOAMed
Reposted by Justin Morgenstern
💯💯 From my viewpoint in critical care the primary risk of the steroid protocol is (as I think you stated) diagnostic delays
Every year we see several people who are seriously harmed by diagnostic failures 2/2 irrational fears of CT scans
If you're critically ill we really need to know why, ASAP
Every year we see several people who are seriously harmed by diagnostic failures 2/2 irrational fears of CT scans
If you're critically ill we really need to know why, ASAP
November 18, 2025 at 2:14 PM
💯💯 From my viewpoint in critical care the primary risk of the steroid protocol is (as I think you stated) diagnostic delays
Every year we see several people who are seriously harmed by diagnostic failures 2/2 irrational fears of CT scans
If you're critically ill we really need to know why, ASAP
Every year we see several people who are seriously harmed by diagnostic failures 2/2 irrational fears of CT scans
If you're critically ill we really need to know why, ASAP
Reposted by Justin Morgenstern
Contrast may cause anaphylacTOID reactions (not anaphyLAXIS)
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
Stop using steroids to pretreat CT contrast allergy
youtube.com/watch?v=h2Hv...
youtube.com/watch?v=h2Hv...
Steroids are OUT for CT contrast allergy
YouTube video by First10EM
youtube.com
November 18, 2025 at 1:51 PM
Contrast may cause anaphylacTOID reactions (not anaphyLAXIS)
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
(anaphylactoid rxns = angry mast cells spit out histamine; usually less severe than anaphylaxis)
Canadian guidelines: don't pre-treatment w/ steroid, give antihistamine
This makes physiological sense!
Thank you science! #1/3. #EMIMCC
Stop using steroids to pretreat CT contrast allergy
youtube.com/watch?v=h2Hv...
youtube.com/watch?v=h2Hv...
Steroids are OUT for CT contrast allergy
YouTube video by First10EM
youtube.com
November 17, 2025 at 11:58 PM
Stop using steroids to pretreat CT contrast allergy
youtube.com/watch?v=h2Hv...
youtube.com/watch?v=h2Hv...
Stop using steroids to pretreat contrast allergy!
The CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity #FOAMed
The CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity #FOAMed
Stop using steroids to pretreat contrast allergy! (CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity)
I have spent a lot of time summarizing the evidence and trying to dispel myths when it comes to contrast and kidney injury. (Bottom line: we have massive amounts of evidence, and in controlled studies with modern contrast agents, we cannot find even the smallest hint of harm from contrast.) However, there is another persistent aggravation when it comes to ordering contrast CTs: allergies and arcane allergy protocols.
first10em.com
November 17, 2025 at 11:20 AM
Stop using steroids to pretreat contrast allergy!
The CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity #FOAMed
The CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity #FOAMed
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Jul 30;97:193-199. doi: 10.1016/j.ajem.2025.07.061. Epub ahead of print.
first10em.com
October 27, 2025 at 10:20 AM
Research Roundup (October 2025)
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
There are, I think, some very interesting papers this time around. Physicians vs AI: ECG edition Shroyer S, Mehta S, Thukral N, Smiley K, Mercaldo N, Meyers HP, Smith SW. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs.…
Less is more when it comes to antibiotics. If you are still counselling your patients to take their full course, stop.
Antibiotics: less is more?
Why do so many antibiotics get prescribed for a week? Is there something special about 7 days of therapy? Would we ever use the number 7 in any other context? The courses of antibiotics we prescribe are clearly not scientific, which has always made the lecture that patients receive about finishing their entire course of antibiotics sounds pretty stupid. Thankfully, a lot of attention has been paid to shortening antibiotic courses over the last few years.
first10em.com
October 6, 2025 at 10:03 AM
Less is more when it comes to antibiotics. If you are still counselling your patients to take their full course, stop.
Amyloid-related imaging abnormalities: an emergency medicine nightmare?
If you had asked me 5 years ago whether a disease modifying agent for Alzheimer’s disease would be developed, I would have laughed. “Moonshot; million to one; when pigs can fly”. Seems like I am as good at predicting the…
If you had asked me 5 years ago whether a disease modifying agent for Alzheimer’s disease would be developed, I would have laughed. “Moonshot; million to one; when pigs can fly”. Seems like I am as good at predicting the…
Amyloid-related imaging abnormalities: an emergency medicine nightmare?
If you had asked me 5 years ago whether a disease modifying agent for Alzheimer’s disease would be developed, I would have laughed. “Moonshot; million to one; when pigs can fly”. Seems like I am as good at predicting the future as I am at hitting a golf ball. Although there is some debate about their true benefit, such therapies now exist, in the form of anti-amyloid monoclonal antibodies.
first10em.com
September 22, 2025 at 1:43 PM
Amyloid-related imaging abnormalities: an emergency medicine nightmare?
If you had asked me 5 years ago whether a disease modifying agent for Alzheimer’s disease would be developed, I would have laughed. “Moonshot; million to one; when pigs can fly”. Seems like I am as good at predicting the…
If you had asked me 5 years ago whether a disease modifying agent for Alzheimer’s disease would be developed, I would have laughed. “Moonshot; million to one; when pigs can fly”. Seems like I am as good at predicting the…
The First10EM Research Roundup for September 2025
It has been a while since I have critically appraised. Life without medical journals is sort of nice, but I guess it just isn’t me, so I am back and nerdier than ever. That means there are some strange selections this time around, but there are…
It has been a while since I have critically appraised. Life without medical journals is sort of nice, but I guess it just isn’t me, so I am back and nerdier than ever. That means there are some strange selections this time around, but there are…
The First10EM Research Roundup for September 2025
It has been a while since I have critically appraised. Life without medical journals is sort of nice, but I guess it just isn’t me, so I am back and nerdier than ever. That means there are some strange selections this time around, but there are bound to be at least a few people out there that find these papers as fascinating as I do.
first10em.com
September 15, 2025 at 10:19 AM
The First10EM Research Roundup for September 2025
It has been a while since I have critically appraised. Life without medical journals is sort of nice, but I guess it just isn’t me, so I am back and nerdier than ever. That means there are some strange selections this time around, but there are…
It has been a while since I have critically appraised. Life without medical journals is sort of nice, but I guess it just isn’t me, so I am back and nerdier than ever. That means there are some strange selections this time around, but there are…
The continuing quest to treat numbers, not patients (OPTRESS) #FOAMed
The continuing quest to treat numbers, not patients (OPTRESS)
Might elderly patients, with a higher risk of undiagnosed hypertension and higher rates of vascular disease, require higher blood pressure targets in sepsis? Or might this just be yet another example of medicine doing harm in the quest of better numbers on a monitor?
first10em.com
September 8, 2025 at 10:23 AM
The continuing quest to treat numbers, not patients (OPTRESS) #FOAMed
In a beautiful park, by the ocean, on a sunny day, with my boy
Remember why you do what you do
Remember why you do what you do
July 28, 2025 at 5:27 PM
In a beautiful park, by the ocean, on a sunny day, with my boy
Remember why you do what you do
Remember why you do what you do
The First10EM wrap-up: Updates on the website, interesting media, good FOAMed, and random thoughts
The First10EM wrap-up for Spring 2025
The First10EM monthly wrap up is a place for me to share updates about the website, about my academic life, and also interesting content, such as books, podcasts, and other FOAMed, that I have encountered in the prior month. First, I have obviously been on a bit of a hiatus. I haven’t published anything since April, and I also took a pretty long break in January and February.
first10em.com
June 30, 2025 at 2:51 PM
The First10EM wrap-up: Updates on the website, interesting media, good FOAMed, and random thoughts
Reposted by Justin Morgenstern
If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
June 14, 2025 at 9:42 AM
If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
@first10em.bsky.social vs @emcrit.bsky.social #EMIMCC
Noah Wiley on an episode of the the SGEM?? Absolutely crazy episode of FOAMed
pca.st/episode/2558...
pca.st/episode/2558...
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pca.st
May 17, 2025 at 1:12 AM
Noah Wiley on an episode of the the SGEM?? Absolutely crazy episode of FOAMed
pca.st/episode/2558...
pca.st/episode/2558...
Reposted by Justin Morgenstern
New World Screwworm
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
New World Screwworm
I have seen a few patients with cutaneous botfly larvae (proper medical terminology being furuncular myiasis) in my career. They are extremely gross, but relatively easy to deal with. However, I had never seen (or even heard of) their much nastier cousins: the New World Screwworm. The scientific name of the New World Screwworm is Cochliomyia hominivorax. Consider that name.
first10em.com
April 28, 2025 at 3:53 PM
New World Screwworm
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
Reposted by Justin Morgenstern
This... is disturbing. Thanks for sharing this education... I think.
April 28, 2025 at 10:58 PM
This... is disturbing. Thanks for sharing this education... I think.
New World Screwworm
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
New World Screwworm
I have seen a few patients with cutaneous botfly larvae (proper medical terminology being furuncular myiasis) in my career. They are extremely gross, but relatively easy to deal with. However, I had never seen (or even heard of) their much nastier cousins: the New World Screwworm. The scientific name of the New World Screwworm is Cochliomyia hominivorax. Consider that name.
first10em.com
April 28, 2025 at 3:53 PM
New World Screwworm
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
It is fascinating. It is disgusting. It is on the rise, and so although we would all probably prefer not to see this, it is something we need to know #FOAMed
The PECARN c-spine rule will cause a lot of harm (if anyone is silly enough to use it)
The PECARN c-spine rule could cause a lot of harm - First10EM
The PECARN c-spine rule should not be used at this time. A critical appraisal and discussion of this new decision rule.
first10em.com
April 24, 2025 at 3:50 PM
The PECARN c-spine rule will cause a lot of harm (if anyone is silly enough to use it)
Is “First do no harm” a “deepity”?
Is "First do no harm" a "deepity"? - First10EM
Is first do no harm a statement that only seems profound, but is actually either completely trivial or manifestly false?
first10em.com
April 23, 2025 at 10:02 AM
Is “First do no harm” a “deepity”?
Reposted by Justin Morgenstern
For us it’s about exactly the elements in your last paper - recognising that sometimes the situation doesn’t fit the protocol or policy. The reporting provides an opportunity to ascertain whether the policy needs to change.
April 22, 2025 at 7:06 PM
For us it’s about exactly the elements in your last paper - recognising that sometimes the situation doesn’t fit the protocol or policy. The reporting provides an opportunity to ascertain whether the policy needs to change.
Reposted by Justin Morgenstern
Nice! It might interest you to know that NSW ambulance has pathways for reporting and analysing “variance to practice”, another thing I think many hospitals could learn from.
April 22, 2025 at 6:44 PM
Nice! It might interest you to know that NSW ambulance has pathways for reporting and analysing “variance to practice”, another thing I think many hospitals could learn from.
Reposted by Justin Morgenstern
My latest for @thestar.com, on the national crisis that doesn't seem to a part of the election.
www.thestar.com/opinion/cont...
www.thestar.com/opinion/cont...
As a family physician I have to turn away patients. This is part of a national crisis that requires a national response
We know how to end the emergency in primary care. Electoral platforms are a starting point, but our next prime minister must go further. No one has a monopoly on
www.thestar.com
April 22, 2025 at 12:35 PM
My latest for @thestar.com, on the national crisis that doesn't seem to a part of the election.
www.thestar.com/opinion/cont...
www.thestar.com/opinion/cont...