Emergency Medicine Cases

In this EM Cases update on cardiac arrest management, Dr. Sheldon Cheskes and Dr. Rob Simard join Anton to walk us through the evolving science and bedside practicalities of cardiac arrest management in the wake of the 2025 ACLS Guidelines. They answer questions such as: What are the most common failures in CPR quality, and how can we recognize and correct them in real time? Should we employ head up CPR, and if so how? How should we interpret ETCO₂ during cardiac arrest, and why shouldn’t we chase a single number? How can we minimize peri-shock pauses and optimize defibrillation success at the bedside? Is the traditional two-minute CPR cycle too rigid, and should we be shocking earlier in cases of refibrillation? What is the evidence behind dual sequential external defibrillation (DSED), and when should we use it? After 3 shocks or earlier? How does hyperventilation during cardiac arrest harm patients, and what strategies can reliably prevent it? What is compression-adjusted ventilation (CAV), and how can it improve ventilation consistency during resuscitation? What is the optimal dose of epinephrine in patient with Ventricular Fibrillation? and many more... Please donate to EM Cases to ensure ongoing Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/
This is a deep dive into the critical inflection points in resuscitation where small changes in technique and decision-making may have the greatest impact on outcomes.

In this month's EM Quick Hits Podcast we introduce not one, but two new series! First, "EMC²" - EM Cases Cases (we know, horrible name ;) where Anton or Katie discuss a knowledge building case with a special guest. And second, "Coaching the EM Mind" with Dr. Sara Gray a professional coach for EM providers, where Katie discusses with her the science and best expert advice on how to perform your best in the ED. Plus, a withdrawal syndrome that is new EDs, life-threatening and requires specific treatment - metetomadine withdrawal, EMS handover done right, why community ED docs should not use the PECARN C-spine Rule and Part 2 of Petro's tips on management of traumatic pneumothorax... Please consider a donation to ensure EM Cases continues to be Free Open Access here: https://emergencymedicinecases.com/donation/

We walk you through what Emergency Physicians need to know to recognize, risk stratify, and manage endometriosis safely and pragmatically. We answer question such as: When should endometriosis rise to the top of the differential for pelvic pain? How do we distinguish an endometriosis flare from a  dangerous endometriosis complication? from Pelvic Inflammatory Disease? Why hemorrhagic cyst the most common misdiagnosis for endometriosis and how can we tell the difference between hemorrhagic cyst and endometrioma? Which hormonal therapy is safe, reasonable and effective to start in the ED? What are the most common life-threatening complications of endometriosis we should be on the lookout for in the ED? How do we discharge patients with suspected endometriosis safely and reduce repeat visits? and many more... Please consider a donation to EM Cases to ensure continued free open access medical education here: https://emergencymedicinecases.com/donation/

Convulsive status epilepticus is one of the most morbid neurologic emergencies we manage in the ED, and outcomes depend far more on speed than drug selection. Like ventricular fibrillation, each minute of ongoing convulsions worsens hypoxia, acidosis, cardiovascular instability, and neuronal injury, while making seizures progressively harder to terminate. Modern definitions are intentionally time-compressed to force early, parallel, clock-anchored action. Any patient still convulsing when you reach the bedside should be treated as evolving status epilepticus.

In this EM Cases podcast with Dr. Sara Gray, we take a practical, time-based approach to convulsive status epilepticus, focusing on early, adequately dosed benzodiazepines, avoiding common escalation and dosing pitfalls, anticipating post-ictal cardiovascular collapse, and knowing when to escalate to second-line agents, airway control, and anesthetic-dose therapy. We also address the transition to non-convulsive status epilepticus and how to recognize ongoing seizures when EEG is not immediately available.

We answer questions such as: Why does time to first benzodiazepine matter more than the drug or route? What critical actions should occur in parallel with the first dose? What are 3 key actions to do in parallel with the first benzodiazepine? Why is underdosing second-line antiseizure medications—especially levetiracetam—a common and dangerous pitfall? When should persistent seizures trigger intubation and anesthetic-dose therapy? How can we identify non-convulsive status epilepticus once tonic-clonic activity stops? And many more (we also include a high yield status epilepticus management algorithm in the show notes!)...

If you find EM Cases helpful in your clinical practice, please consider supporting our work so we can continue producing free, high-quality emergency medicine education for clinicians around the world.
Make a donation here: https://emergencymedicinecases.com/donation/

If you’ve been practicing EM for more than a decade, your approach to the febrile young infant has (appropriately) evolved. For years, the default was LP + empiric antibiotics + admission for almost everyone. That approach prevented missing meningitis, but at the cost of a lot of harm: invasive testing, unnecessary antibiotics, and hospitalization-related complications. The modern approach is a paradigm shift toward risk stratification, biomarkers, and shared decision-making, while still respecting one immutable truth: Missing neonatal bacterial meningitis can be catastrophic. This episode revisits the framework from a prior EM Cases episode and updates it with a landmark study that directly informs how far we can safely go—especially in the 0–28 day group, with the father of multiple well-known PECARN rules Dr. Nathan Kuppermann and lead author Dr. Brett Burstein...