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Maintaining a high suspicion for botulism is crucial in making a prompt diagnosis and in reducing morbidity and mortality. This review highlights pearls and pitfalls of diagnosis and management.

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High risk and low prevalence diseases: Botulism. Am J Emerg Med. 2024 Aug;82:174-182. doi: 10.1016/j.ajem.2024.06.018. Epub 2024 Jun 20. PMID: 38925095.

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In this phase 2b randomized clinical trial of scheduled intravenous acetaminophen for critically ill sepsis patients, authors confirmed the safety of this strategy, but found no improvement in days alive and free of organ support.

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Acetaminophen for Prevention and Treatment of Organ Dysfunction in Critically Ill Patients With Sepsis: The ASTER Randomized Clinical Trial. JAMA. 2024;332(5):390-400. PMID: 38762798.

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This retrospective study suggests that full dose antibiotic challenges for patients with listed beta-lactam antibiotic allergies can be safely accomplished in the ED.

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Full-dose challenge of moderate, severe, and unknown beta-lactam allergies in the emergency department. Acad Emerg Med. 2024 Aug;31(8):777-781. doi: 10.1111/acem.14893. Epub 2024 Mar 21. PMID: 38511401.

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Among patients with suspected sepsis in the ED, the implementation of a 1-hour sepsis bundle was not associated with significant difference in in-hospital mortality.

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Effect of the 1-h bundle on mortality in patients with suspected sepsis in the emergency department: a stepped wedge cluster randomized clinical trial. Intensive Care Med. 2024 Jul;50(7):1086-1095. doi: 10.1007/s00134-024-07509-1. Epub 2024 Jun 24. PMID: 38913098.

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Due to a multitude of factors, the tick population is increasing, leading to a congruent increase in tick-borne diseases (TBD), most notably Lyme disease and babesiosis. Clinicians should keep TBD on their differential for fever with flu-like symptoms, even in traditionally non-endemic areas, as range is expanding and travel has increased.

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Increasing Risk for Tick-Borne Disease: What Should Clinicians Know? JAMA Intern Med. 2024 Aug 1;184(8):973-974. PMID: 38829668.

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We need your input on wisely and ethically using AI. Also, see if you can you tell what's AI vs human-written.

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These researchers developed and trained a deep ensemble artificial intelligence (AI) model to classify ECGs as STEMI versus non-STEMI. The AI performed well in both accuracy and in improving sensitivity.

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Development of Clinically Validated Artificial Intelligence Model for Detecting ST-segment Elevation Myocardial Infarction. Ann Emerg Med. 2024 Jul 25:S0196-0644(24)00327-5. doi: 10.1016/j.annemergmed.2024.06.004. Epub ahead of print. PMID: 39066765.

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Physician humility is crucial for tackling modern healthcare challenges, building patient trust, and fostering collaboration in medical environments. However, significant challenges exist in cultivating humility and require substantial individual and collective actions to ensure the integrity of the medical profession, enhance patient care, and support healthcare providers’ well-being.

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Physician Humility: A Review and Call to Revive Virtue in Medicine. Ann Intern Med. 2024 Jul 30. doi: 10.7326/M24-0842. Online ahead of print. PMID: 39074373.

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Tell us what you think about a potential new JF summary that incorporates AI, and see if you can tell which post was written by AI vs written by me. We will share these findings with the whole audience, but we need a bunch more responses to make sure these data are meaningful.

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In a cohort of afebrile infants with pustular or vesicular rashes, none were diagnosed with serious bacterial infection attributable to a skin source, though some were ultimately diagnosed with herpes simplex virus (HSV).

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Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology. Pediatrics. 2024 Jul 1;154(1):e2023064364. doi: 10.1542/peds.2023-064364. PMID: 38910522.

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Patients on GLP-1 agonists might be at risk of delayed gastric emptying, which has significant implications for procedural sedation and endotracheal intubation.

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Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007. PMID: 39032988.

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There are an increasing number of water bead related injuries in children, with the majority occurring in children less than five. While most cases can be treated and released from the ED, water bead injury can be serious and even deadly.

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Pediatric water bead-related visits to United States emergency departments. Am J Emerg Med. 2024 Jul 28:84:81-86. doi: 10.1016/j.ajem.2024.07.048. Online ahead of print. PMID: 39096713