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ED stress testing, in addition to standard workup with ECG and biomarkers, led to more downstream testing (angiography) and more interventions (PCI or CABG), but this didn't translate into fewer acute myocardial infarctions at one year.

If clinical gestalt for PE is low, use PERC to rule out PE.  If not ruled out, use a validated tool to determine pretest probability of PE: Wells, Revised Geneva, or simplified versions of either score.  If non-high or "unlikely" pretest probability, order D-dimer, adjusting for age (<500 or <age x 10).  If D-dimer is negative, PE is ruled out.  If positive, order CT pulmonary angiogram.

A negative c-spine CT had 99.9% NPV for clinically significant c-spine injury in intoxicated patients.  The Western Trauma Association recommends c-spine clearance, even in intoxicated patients, if gross motor function is normal, no neurologic complaints, and negative c-spine CT per experienced radiologist.  Be careful out there, and get institutional buy-in if you plan to put this into practice.

A simplified Geneva Score is safe to use in place of the Geneva score and is straightforward, with each criterion being worth one point.  Low to Intermediate pretest probability plus negative D-dimer with the simplified Geneva ruled out PE as well as the regular Geneva score.

This was a fun article that searched the literature and dispensed with 10 myths about cellulitis.

This early study of thrombolytics plus heparin for submassive PE showed no mortality benefit but did show a decrease in need for escalation of care compared with heparin alone.  Subsequent studies call lytics for submassive PE into question, so take the current evidence into account.

More patients are having operative repair for displaced midshaft clavicle fractures.  This meta-analysis of 6 RCTs found that the rate of nonunion was markedly reduced and final functional outcome was also improved (though not as strikingly) with operative management.

Noninvasive measurement of ejection fraction with an iPhone app is possible and very accurate.  When this becomes publicly available, it will be a game changer.

Don't use IV magnesium for bronchiolitis.  It doesn't work, and it may cause harm.

Excessive sedation of intubated adult patients in the ED was associated with increased in-hospital mortality.  Aim for a RASS > -3.