Justin Morgenstern

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.

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 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.

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…

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.

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…

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?

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

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.

The First10EM wrap-up: Updates on the website, interesting media, good FOAMed, and random thoughts

If interested in ketamine for status, great debate emcrit.org/emcrit/ketam...
@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...

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.

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

This... is disturbing. Thanks for sharing this education... I think.

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.

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

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.

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"? - First10EM Is first do no harm a statement that only seems profound, but is actually either completely trivial or manifestly false?

Is “First do no harm” a “deepity”?

I am not sure equating judgement to decision rules is appropriate
Decisions rules are simplified - pared down judgement; they are rigid; they don't have anything like the complexity of expert judgement

Both should be studied
Thus far, rules have essentially never won

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.

Has NSW ambulance published on their program?
Seems like the kind of thing Casey and I like to banter about

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.

I like the idea of measuring variance, but I always worry about the set point
Excellence is variance from baseline, but not something to be wheeled in
Most attempts to diminish variance I have seen in North America seem to aim more towards mediocracy

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

My latest for @thestar.com, on the national crisis that doesn't seem to a part of the election.

www.thestar.com/opinion/cont...

YouTube video by EMSwami Thyroid Storm Diagnosis #criticalcare #emergencymedicine #resuscitation

Thyroid storm diagnosis
1) TSH results can be delayed + not always available
2) Burch-Wartofsky scale: bedside clinical scoring system that requires no testing
3) High suspicion = immediate management

youtube.com/shorts/E_U_V...
#EMIMCC #MedSky

'Can you send me your "presentation"?'

No. My slides are visual aids within my presentation. If your slides are so text-heavy that they contain all the information, you didn't do a presentation but a narrated collective document reading.

Also, no you can't have my visual aids. Make your own.

Research Roundup for April 2025 I took a few months off. (Well, not so much off, but as stuck in other EBM rabbit holes.) I am sure some were happy for the empty inbox, but if you enjoy nerdy conversation about subpar medical research, this is your luck day.

The First10EM Research Roundup for April 2025 #FOAMed

Research Roundup for April 2025 I took a few months off. (Well, not so much off, but as stuck in other EBM rabbit holes.) I am sure some were happy for the empty inbox, but if you enjoy nerdy conversation about subpar medical research, this is your luck day.

The First10EM Research Roundup for April 2025 #FOAMed

Seeing many people confuse correlation with causation when it comes to vaccines & autism.
Reminded me of this science joke. #MedSky

Canada comes second last out of 20 countries in new health-care ranking

Seems like this should be an election priority ... Why such silence from our major parties??

financialpost.com/opinion/cana...

The pediatric can't intubate can't oxygenate scenario (Use a knife) - First10EM A review of the evidence for the pediatric can't intubate can't oxygenate scenario. Bottom line: use a knife not a needle.

The pediatric can’t intubate can’t oxygenate scenario (Use a knife) #FOAMed

“what do you understand about your condition?”

“only what they’ve told me”

“what have they told you?”

“it’s in my chart”

“can you summarize it for me?”

“doc, i’ve been a patient since before you were born. i know how to evade any question to conceal my cognitive decline. i can do this all day”

Post Image

A pediatric transfusion dosing guide from McMaster Children's Hospital

https://first10em.com/pediatric-transfusion-dosing/

Andexanet alfa: expensive and harmful? - First10EM Andexanet alfa: there was no reason to use this drug until now, and nothing changes with this first RCT. Harmful and expensive.

Andexanet alfa: expensive and harmful?

I think a good way is to debrief with good judgement, let the learner to search for ways to improve in a sort of maieutic method. Many times there's no wrong or right but there's a mental process that has to be vivisected to find the answer. This is my short thought on the topic #FOAMed #EMIMCC