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One of the benefits of Premium membership is the monthly top 10. Here are ten articles that have impacted my care. This month, we have a variety of articles across the spectrum of EM. Note, the heading/title of each article links to the original post.
I also want to make sure you are aware of some new things we are doing at JournalFeed to help you learn even better.
1. We’ve added new Critical Appraisal to the bottom of most posts as a dropdown.
2. We are planning a LIVE conference. We would love to see you there!
All my best,
Clay
Clay Smith, MD
Chief Spoon-Feeder, JournalFeed
Written by Clay Smith
1. Hyperkalemia – Can We Use Succinylcholine for RSI?
Spoon Feed
This retrospective cohort study found no 24-hour mortality difference when intubating hyperkalemic patients (K > 5.5mmol/L) with succinylcholine versus rocuronium for RSI.
Comment
While I don’t recommend a cavalier approach, this is reassuring that in patients with mildly increased or unknown potassium, succinylcholine appears safe.
Source
Hyperkalemic emergency department patients intubated with rocuronium or succinylcholine: Retrospective study of clinical outcomes. Am J Emerg Med. 2025 Dec 2;100:154-164. doi: 10.1016/j.ajem.2025.11.030. Epub ahead of print. PMID: 41380422.
2. Can AI Predict Pediatric Sepsis Before It Happens?
Spoon Feed
Using EHR data from the first 4 hours of ED care, machine learning models accurately predicted which children would develop sepsis within 48 hours—before organ dysfunction was present.
Comment
This was not technically AI. However, it gives us a window into the future. If routine variables in the EHR can accurately predict important outcomes, this will soon help us with disposition decisions and earlier initiation of treatment.
Source
Derivation and Validation of Predictive Models for Early Pediatric Sepsis. JAMA Pediatr. 2025 Dec 1;179(12):1318-1325. doi: 10.1001/jamapediatrics.2025.3892. PMID: 41082207; PMCID: PMC12519407.
3. Febrile Neonates Under 28 Days – Is PECARN Rule Safe?
Spoon Feed
In a large international cohort of well-appearing febrile infants ≤28 days old, the updated PECARN rule had high sensitivity and negative predictive value for invasive bacterial infection, with no missed cases of bacterial meningitis, supporting selective avoidance of routine lumbar puncture in low-risk neonates.
Comment
Don’t miss Dr. Josh Belfer’s interview with lead author Dr. Burstein and senior author Dr. Kuppermann on his blog HipPEMcrates.com.
Source
Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. 2025 Dec 8:e2521454. doi: 10.1001/jama.2025.21454. Epub ahead of print. PMID: 41359314; PMCID: PMC12687207.
4. Slow and Steady – Be Careful with ICH BP Control
Spoon Feed
In this retrospective multicenter study, both early, overly rapid systolic blood pressure (SBP) reduction after intracerebral hemorrhage (ICH) and overshooting SBP targets (<120 mmHg) were linked with worse functional outcomes at discharge.
Comment
We covered an article a few years ago that suggests we should maybe stop at ~140 systolic for ICH. Whatever you do for BP in ICH, go “low and slow,” and don’t overshoot.
Source
Early Intensive Blood Pressure Reduction After Intracerebral Hemorrhage Is Associated With Worse Functional Outcome: The Risk of Overshooting Blood Pressure Goals. Ann Emerg Med. 2025 Dec 9:S0196-0644(25)01303-4. doi: 10.1016/j.annemergmed.2025.10.009. Epub ahead of print. PMID: 41369631; PMCID: PMC12757810.
5. Block Better – PENG Blocks for Hip Fractures
Spoon Feed
Ultrasound-guided pericapsular nerve group (PENG) blocks significantly improve short-term pain control and reduce opioid requirements in adult ED patients with hip fractures without increasing adverse events.
Comment
Nerve blocks are increasingly being incorporated into EM practice. This form of block markedly reduced pain and need for opioids in this vulnerable population.
Source
Efficacy of Ultrasound-Guided PENG Block for Acute Pain Relief in Adult Hip Fracture Patients: A Double-Blind Randomized Trial. Acad Emerg Med. 2025 Dec 12. doi: 10.1111/acem.70206. Epub ahead of print. PMID: 41387636.
6. Reducing Delirium with Fascia Iliaca US-Guided Block
Spoon Feed
In this multicenter randomized trial of elderly patients with hip fractures, there was a significant reduction in delirium in those patients who received ultrasound-guided fascia iliaca blocks.
Comment
The benefits of this block went beyond pain control and opioid consumption. This block reduced delirium, an important, patient-centered outcome. See this video on how to do the fascia iliaca block.
Source
Ultrasound-Guided Regional Anesthesia by Emergency Physicians for Hip Fractures and Delirium: A Randomized Clinical Trial. JAMA Netw Open. 2025 Dec 1;8(12):e2549337. doi: 10.1001/jamanetworkopen.2025.49337. PMID: 41396601; PMCID: PMC12706686.
7. Repeat Naloxone Doses Increasing—Watch These Patients!
Spoon Feed
This retrospective analysis found an increased rate of repeat naloxone administration in US EDs from 2016–2022.
Comment
Patients with opiate use disorder and overdose may have unwittingly used new, potent synthetic opioids called nitazenes. We covered this last month as well, but here is what you need to know about nitazenes. Since repeat naloxone dosing due to renarcotization is on the rise, try to watch these patients up to 6 hours. It’s hard to get them to stay once they have received naloxone. My colleague, Matt Lipton, emailed me and pointed out that nasal nalmefene has a longer duration of action than naloxone and may be an option for patients who will not stay for observation. However, at this point, I cannot find solid evidence for this practice, though it makes sense in theory. Use caution, but I throw it out there for your consideration.
Source
Use of Multiple Naloxone Administrations in the Emergency Department: A Retrospective Claims-Based Analysis. J Emerg Med. 2025 Dec;79:111-122. doi: 10.1016/j.jemermed.2025.04.022. Epub 2025 May 8. PMID: 41129837.
8. Best Vagal Maneuver for SVT
Spoon Feed
The modified Valsalva maneuver is the most effective first-line vagal maneuver for stable supraventricular tachycardia, achieving higher conversion rates and reducing the need for intravenous antiarrhythmics without increasing adverse events.
Comment
Just how do we modify the modified Valsalva? See this Lancet article, the REVERT RCT. Better yet, download the REVERT video from the Lancet demonstrating the “manoeuvre.”
Source
Pursuit of Optimal Vagal Maneuvers in Stable Supraventricular Tachycardia: A Network Meta-Analysis. West J Emerg Med. 2025 Nov 26;26(6):1667-1678. doi: 10.5811/westjem.47305. PMID: 41380061; PMCID: PMC12698150.
9. Another Positive Trial for Steroids and Pneumonia
Spoon Feed
This RCT demonstrated modest reduction in 30-day mortality for patients with community-acquired pneumonia (CAP) in Kenya who received a 10-day course of glucocorticoids.
Comment
I think the evidence strongly favors steroids in severe CAP. For less severe CAP, benefit is questionable. Also, this population (18 centers in Kenya) does not generalize well to a U.S. setting.
Source
A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. N Engl J Med. 2025 Dec 4;393(22):2187-2197. doi: 10.1056/NEJMoa2507100. Epub 2025 Oct 29. PMID: 41159889; PMCID: PMC12659994.
10. Do Prehospital Pelvic Binders Cause More Harm Than Good?
Spoon Feed
In the prehospital setting, universal application of pelvic circumferential compression devices with suspected pelvic injuries could lead to adverse iatrogenic effects which are further compounded by improper diagnosis and thus misapplication, poor technique when deployed, and a false sense of security, which could lead to bias in recognizing other fatal causes of shock and bleeding.
Comment
There was a lot of discussion and debate about this on my TikTok post about this article. See the comments if you’re into TikTok…
Source
Prehospital Trauma Compendium: Evaluation and Management of Suspected Pelvis Fractures – An NAEMSP Position Statement and Resource Document. Prehosp Emerg Care. 2025 Aug 11:1-35. doi: 10.1080/10903127.2025.2540420. Epub ahead of print. PMID: 40729523.
