The Skeptics Guide to Emergency Medicine

Date: March 4, 2026 Guest Skeptic: Prof Carl Heneghan is a General Practitioner, Professor of Evidence-Based Medicine at the University of Oxford and current Director of the Centre for Evidence-Based Medicine (CEBM). Today, we’re launching a brand-new SGEM series: Legends of Evidence-Based Medicine (EBM). In the past, I’ve interviewed legends of Emergency Medicine: Dr. Diane Birnbaumer, Dr. Ian Stiell, Dr. Jerome Hoffman, Dr. Joe Lex, Dr. Richard Bukata, Dr. Andrew Worster and Dr. Judith Tintinalli. But today, we pivot to the people who shaped how we think about evidence itself. I first met Carl back in 2012 when I took the Teac...

Reference:  Perry DC, et al. Surgical fixation versus non-surgical care for children with a displaced medial epicondyle fracture of the elbow (the SCIENCE study): a multicentre, randomised controlled, superiority trial and economic evaluation. The Lancet 2026 Date: July 14, 2026 Guest Skeptics: Dr. Megan Terle is an orthopedic surgeon and Assistant Professor for Pediatrics and Trauma services at UC Davis Health. She completed her orthopedics residency at the University of Washington and completed two fellowships, one in pediatrics at the University of Washington and one in trauma at UC Davis. Dr. Megan Terle Dr. Holly Leshikar is also an orthopedic surgeon and Associate P...

Date: July 27, 2026 2026 Guest Skeptic: Dr. Howard (Howie) Mel is an emergency physician and FACEP.  Reference: Smith JE et al. SWiFT Trial Group. Prehospital Whole Blood in Traumatic Hemorrhage - a Randomized Controlled Trial. NEJM 2026 March Case: A 36-year-old man is brought to the emergency department (ED) by air ambulance after a high-speed motorcycle crash. Paramedics report blunt polytrauma, transient hypotension, tachycardia, pelvic instability, and concern for intra-abdominal bleeding. IV/IO access was obtained in the field, and prehospital blood was started. On arrival, he is pale, cool, and diaphoretic, with blood pressure (BP) 86/52 mm Hg, heart rate (HR) 128 bpm, Glasgow C...

Date: July 9, 2026 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Vice Chair of Critical Care Medicine at Mayo Clinic Arizona. Aaron is a full-time multidisciplinary intensivist and is the medical student clerkship director for critical care.  Today’s episode is a little different. We’re diving into a classic 80s TV show. Aaron and I were in Hawaii earlier this year at the Center for Continuing Medical Education Emergency Medicine and Acute Care Course. While walking down the beach, Aaron told me how much he loved Magnum PI. T...

Reference:  Denninghoff KR et al. Azithromycin for Preschoolers with Wheezing in the Emergency Department. New England Journal of Medicine. May 2026 Date: July 14, 2026 Dr. Zara Ibrahim Guest Skeptic: Dr. Zara Ibrahim is a pediatric emergency medicine fellow at Children’s National Hospital in Washington DC where she also completed medical school, pediatric residency. Her research interests include AI applications in medicine and health equity. In her time off, Zara likes to read books, travel, go on long walks to explore DC's excellent bakery scene, and do HIIT workouts to balance out the pastries. Case: A 3-year-old with a history of recurrent whe...

Date: July 9, 2026 Reference: The ARISE FLUIDS Investigators. Vasopressors or Fluids in Early Septic Shock. NEJM June 2026.  Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Vice Chair of Critical Care Medicine at Mayo Clinic Arizona.  He is board-certified in Emergency Medicine, Medical Toxicology, Addiction Medicine, Internal Medicine-Critical Care, and Neurocritical Care.  Aaron is a full-time multidisciplinary intensivist and enjoys serving as the medical student clerkship director for critical care. Case: A 69-year-old man presents by EMS to the emergency department (ED) with fever, productive cough, confusion, and weakness. He...

Date: June 23, 2026 Reference: Tagg A, et al. Everything is awesome: Don’t forget the Lego. J Paediatr Child Health. 2019 We recorded this SGEM episode live at the Don't Forget the Bubbles conference in Glasgow, Scotland. Dennis and I had just given an hour presentation on how to build better critical appraisal skills. It was a wonderful experience, and we would like to thank Dr. Tessa Davis, Dr. Andy Tagg, and the entire DFTB team for putting on an amazing event.  Case: A 2-year-old boy is brought to the emergency department (ED) after swallowing a foreign body. His sister was playing wit...

Date: June 12, 2026 Guest Skeptic: Mr. Ross Fisher. Ross is a paediatric surgeon, presentation guru (P-Cubed), and long-time friend of the SGEM.  Reference: Talan et al. Nonoperative Treatment of Appendicitis and Implications for Emergency Department Management: A Narrative Review. Ann Emerg Med. June 2026 Case: A 29-year-old healthy man presents to the emergency department (ED) with 18 hours of abdominal pain that began around the umbilicus and migrated to the right lower quadrant. He has anorexia, nausea, a temperature of 38.1°C, and focal right lower quadrant (RLQ) tenderness without diffuse peritonitis. The white blood cell (WBC) count is 13,500/µL. CT abdomen/pelvis shows an...

Date: April 21, 2026 Lauren Openshaw Guest Skeptic: Lauren Openshaw is a medical student at the George Washington University School of Medicine & Health Sciences, Class of 2027, where she is a part of the Disaster Medicine Scholarly Concentration. Her clinical interests include pediatrics, disaster medicine, critical care, and emergency preparedness, particularly as they relate to protecting vulnerable children during natural disasters and public health crises. Background:  Floods, fires, hurricanes, blizzards, cyberattacks, hospital surges, the list goes on. Disasters are no longer just movie events or rare abstractions. These are real-world events that disrupt and change how we care for patients and families. We sp...

Date: May 20, 2026 Guest Skeptic: Dr. Matt McArthur is an ED Physician working primarily in Guelph and Kitchener with occasional rural locums in the small town of Walkerton, where he grew up. His clinical interests include POCUS, emergency cardiology, QI, knowledge translation, motivational interviewing, and vertigo. He is very active in medical education, including as a clinical skills and POCUS instructor, a Contributing Editor with the EMCases Podcast, and Regional Education Lead for Undergraduate Family Medicine at the Waterloo Regional Campus of McMaster University. Reference: Qiang et al. Safety and Effectiveness of Subcutaneous Insulin for Management of Mild to Moderate Diabetic...

Reference:  Perry DC, et al. Non-surgical casting versus surgical reduction for children with severely displaced distal radial fractures (the CRAFFT Study): a multicentre, randomised, controlled non-inferiority trial and economic evaluation. Lancet April 2026. Date: May 8, 2026 Dr. Andrew Tagg Guest Skeptic:  Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder and website lead of Don’t Forget the Bubbles. Case: A healthy 7-year-old boy presents to the emergency department (ED) with obvious deformity of the wrist after a fall from playground equipment. X-rays show a severely displaced distal radius fracture, with a...

Date: April 23, 2026  Guest Skeptic: Dr. Manrique Umaña McDermott is an attending physician specializing in Emergency Medicine based in San José, Costa Rica. He has a passion for medical education, is a renowned international speaker and serves as a faculty member in undergraduate Internal Medicine at UCIMED and postgraduate training programs in Emergency Medicine and Family and Community Medicine at the University of Costa Rica (UCR). You can follow him on X and Instagram at @umanamd.  Reference: Zhang et al. Coffee and Tea Intake, Dementia Risk, and Cognitive Function. JAMA 2026 March Case: A 47-year-old emergency physician presents to their primary care...

Reference: Burstein B, et al. Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger. JAMA. Published online December 08, 2025. Date: April 3, 2026 Dr. Margarita Ramos Guest Skeptic: Dr. Margarita Ramos is a pediatric hospitalist at Children’s National Hospital in Washington, D.C., and Assistant Professor of Pediatrics at the George Washington University School of Medicine and Health Sciences where completed the Master Teacher Leadership Development Program in 2024. Her scholarly interests include equity in medical education and health services research. Case: A 12-day-old boy is brought to the emergency department (ED) by his parents for fever. At home, he...

Date: April 2, 2026   Reference: Lee et al. GRADE-Based Clinical Practice Guidelines for Emergency Department Delirium Risk Stratification, Screening, and Brain Imaging in Older Patients With Suspected Delirium. AEM Feb 2026 Guest Skeptic: Dr. Christina Shenvi is a board-certified emergency physician, educator, keynote speaker, coach, and academic leader. She is widely recognized for her work in geriatric emergency medicine, faculty development, and professional identity formation in EM. She brings deep clinical expertise along with thoughtful perspectives on systems-level change and guideline development. Case: An 82-year-old woman with hearing impairment and mild baseline dementia is brought to the emergency department (ED) by her daughter be...

Date: March 23, 2026 Dr. Christina Shenvi Guest Skeptic: Dr. Christina Shenvi is a board-certified emergency physician, educator, keynote speaker, coach, and academic leader. She is widely recognized for her work in geriatric emergency medicine, faculty development, and professional identity formation in emergency medicine (EM). She brings deep clinical expertise along with thoughtful perspectives on systems-level change and guideline development. This is another SGEM Xtra episode. Today’s show focuses on how to build high-quality subspecialty clinical practice guidelines, using the Geriatric Emergency Department Guidelines 2.0 (GED 2.0) as a model. We’ve talked about Geriatric EM a lot on the SGEM over the year...

Date: March 26, 2026 Dr. Rob Leeper Guest Skeptic: Dr. Robert Leeper is a trauma surgeon at the London Health Sciences Centre and an ATLS instructor who has helped train generations of physicians in trauma care. He has previously joined SGEM for: SGEM #200 – Bloodletting and Alexander Hamilton SGEM #256 – RLQ Pain and Appendectomy SGEM #345 – Non-operative Management of Appendicitis It’s SGEM Xtra time, where we go beyond a single paper and dive into broader topics that impact our daily practice. Now, some of you may remember that back in 2018, we did a Top 10 list for ATLS 10th Edition. Yes, we cranked it up to 10. A...

Reference: Wong KH, et al. Improving Use of Oral Antihistamines in a Children’s Hospital. Pediatrics. Feb 2026; Date: March 15, 2026 Dr. Stephanie Kubala Guest Skeptic: Dr. Stephanie Kubala is an attending physician in the Division of Allergy and Immunology at Children’s Hospital of Philadelphia. She is double board-certified in both pediatrics and allergy and immunology. Case: A 5-year-old girl is brought in by her parents for an itchy rash. Her symptoms started last night. The parent reports an itchy, raised red rash on her trunk and extremities. She has not had any fever. She does not have any difficulty breathing, whee...

Date: March 11, 2026 Reference: RENOVATE Investigators and the BRICNet Authors; High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial. JAMA March 2025 Guest Skeptic: Dr. Rory Spiegel is an emergency medicine and critical care physician known for his work in evidence-based medicine and critical care. He is widely recognized for translating emerging research into practical bedside insights through lectures, writing, and digital medical education. His work focuses on resuscitation science, airway management, and the critical appraisal of medical literature. I’m in Maui at the Centre for Continuing Medical Education Year in Review Course. CC...

Date: March 5, 2026 Today, we’re not in the studio. We’re not in Canada. We’re not even in North America. We are in Oxford. And not just Oxford, we are recording this SGEM Xtra in a pub. This will be the second-ever SGEM PUBcast. We need to travel back in time to 2012 for the first PUBcast. That happened when I came to Oxford for a mini-fellowship at the Centre for Evidence-Based Medicine (CEBM) on how to teach evidence-based medicine (SGEM#6). I had no idea that experience would change my professional career and open so many doors for me around the wo...

Date: February 26, 2026 Guest Skeptic: Terry O’Reilly is the host of the long-running and popular podcast Under the Influence. He is also an acclaimed storyteller and book writer. However, Terry is not just some radio host talking about marketing; he was an adman on the front lines, working in the trenches for 35 years in the advertising industry. I’ve been a listener of Under the Influence for a long time, and it’s helped me think about how we communicate with emergency clinicians and how we make ideas memorable without overselling them. I see many similarities with Terry. I’m not just...

Reference: . Timing of repeat epinephrine to inform paediatric anaphylaxis observation periods: a retrospective cohort study. Lancet Child & Adolescent Health. July 2025 Dr. Kammeron Brissett Guest Skeptic: Dr. Kammeron Brissett is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. She completed her pediatrics residency and a chief year at Rainbow Babies and Children’s Hospital in Cleveland, Ohio. Her interests include injury prevention, social determinants of health, and advocacy. Case: A 7-year-old boy with a peanut allergy presents to the emergency department (ED) after eating a cookie at a birthday party. Shortly afterwards, he developed hives and whee...

Date: February 13, 2026 Reference: Lang et al. Factors associated with emergency department length of stay in Alberta: a study of patient-, visit-, and facility-level factors using administrative health data. CJEM. 2026 Jan 29. Guest Skeptic: Dr. Paul Parks is an emergency physician from Medicine Hat, Alberta. He has been the President of the Alberta Medical Association (AMA) Section of Emergency Medicine for many years, the AMA Board of Directors for 9 years, and the Previous President of the Alberta Medical Association.  Paul has won the Canadian Association of Emergency Physicians (CAEP) National Teacher of the Year Award and the CAEP Alan Drummond National Advocacy A...

Date: January 3, 2026  Reference: Shroyer et al. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Nov. Guest Skeptic: Dr. Amal Mattu has been on the faculty at the University of Maryland since 1996. He has developed an academic niche in emergency cardiology and electrocardiography, and he also enjoys teaching and writing on other topics, including emergency geriatrics, faculty development, and risk management. Amal is currently a tenured professor and Vice Chair of Emergency Medicine at the University of Maryland School of Medicine, and a Distinguished Professor of t...

Date: January 6, 2026  Guest Skeptic: Darren McKee is an author and speaker. He has served as a senior policy advisor and policy analyst for over 17 years. Darren hosts the international award-winning podcast, The Reality Check. He is also the author of an excellent, thought-provoking book called Uncontrollable: The Threat of Artificial Superintelligence and the Race to Save the World (2023). The book lays out what AI is, why advanced systems could pose real risks, and what individuals and institutions can do to increase AI safety.  We have discussed AI on the SGEM a few times: SGEM Xtra: Rock, Robot Rock – AI for Clini...

Reference: Aronson PL, et al. Prediction Rule to Identify Febrile Infants 61–90 Days at Low Risk for Invasive Bacterial Infections. Pediatrics. September 2025 Date: January 6, 2026 Dr. Jillian Nickerson Guest Skeptic: Dr. Jillian Nickerson is a pediatric emergency medicine attending at Children’s National Hospital and Assistant Professor of Pediatrics and Emergency Medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC. Prior to completing her PEM fellowship, she completed an emergency medicine residency at Mount Sinai in New York. Now she is also the associate program director for the pediatric emergency medicine fellowship program at Children’s Nation...

Date: January 17, 2026 Reference:  Casey et al. RSI Investigators and the Pragmatic Critical Care Research Group. Ketamine or Etomidate for Tracheal Intubation of Critically Ill Adults. NEJM. 2025 Dec Guest Skeptic: Dr. Scott Weingart is an ED Intensivist from New York. He did fellowships in Trauma, Surgical Critical Care, and ECMO. Scott is best known for talking to himself about Resuscitation and Critical Care on the podcast EMCrit, which has been downloaded more than 50 million times. Scott and I will both be presenting at Incrementum 2026 in Spain.  Case:  You’re working an evening shift in a busy tertiary-care emergency department (ED). Emergency Medic...

Date: January 5, 2026 Reference: Robblee et al. 2025 guideline update to acute treatment of migraine for adults in the emergency department: The American Headache Society evidence assessment of parenteral pharmacotherapies. Headache 2025 Dec Happy New Year, SGEMers! What better way to start 2026 than with an SGEM Xtra about migraine headaches? We were originally scheduled to record this episode in December, but circumstances changed. This is another SGEM Xtra and not the typical structured critical appraisal with a checklist. It will be a conversation about what we should be doing and should stop doing when treating migraine patients in the ED based on the...

Date: December 23, 2025 Reference: Todd et al. Antihypertensive prescription is associated with improved 30-day outcomes for discharged hypertensive emergency department patients. J Am Coll Emerg Physicians Open. 2024 Guest Skeptic: Dr. Mike Pallaci is a Professor of Emergency Medicine at Northeast Ohio Medical University and a Clinical Professor of Emergency Medicine at Ohio University Heritage College of Osteopathic Medicine. He currently serves as Core Faculty for the USACS EM Residency at Summa Health System in Akron, OH where he is also Medical Director for the Virtual Care Simulation Lab, Director for the Simulation Medicine Fellowship and Vice Chair for Faculty and Resident...

Date: November 27, 2025  Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are looking after a 65-year-old man who appears to be in septic shock. He presented after five days of fever and cough, and is now severely lethargic and hypotensive on arrival. You give him antibiotics and IV fluids immediately, but an hour later, his lactate comes back at 5, and you need to start norepinephrine to keep his MAP above 65. You put in a call to the intensive care unit (ICU) to get him transferred, and th...

Date: Dec 17, 2025 Reference: Pagnini F, et al. Unexpected events and prosocial behavior: the Batman effect. npj Mental Health Research. November 2025 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine physician at Children’s National in Washington, DC. You may also know him as the host of SGEM Peds. Case: It’s been a dark, cold day in Gotham City. You’re finally on the metro heading home after a long shift. The train is packed, and you’re standing, crammed uncomfortably among all the other citizens eager to get home. Outside, you see the holiday lights and decorations, trying valiantly...

Reference: Binder ZW et al. “Ultrasound-Guided Nerve Block for Pediatric Femur Fractures in the Emergency Department: A Prospective Multi-Center Study.” Academic Emergency Medicine, 2025. Date: November 24, 2025 Dr. Lauren Westafer Guest Skeptic: Dr. Lauren Westafer is an Associate Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School, Baystate. She is the co-founder of FOAMcast and a researcher in pulmonary embolism and implementation science.  Dr. Westafer serves as the research methodology editor for Annals of Emergency Medicine.  Case: A 9-year-old boy presents to the emergency department after a trampoline injury. He was at a party with his friends and th...

Date: December 4, 2025 Guest Skeptic: Dr. Jestin Carlson – Long-time listener, second-time guest.   Reference: Reinaud et al. Reporting of Noninferiority Margins on ClinicalTrials.gov: A Systematic Review. JAMA Netw Open. 2025 Case: You are working with a resident who asks you about a new thrombolytic they heard about on the SGEM for acute ischemic stroke.  This new treatment was found not to be inferior to the existing thrombolytic, but they are not sure how the paper reached that conclusion.  You start to discuss noninferiority margins when the resident asks you, “Are the noninferiority margins reported on ClinicalTrials.gov consistent with the final publications?” Background...

Date: November 26, 2025 Reference: Ray et al. Emergency Department Visit Frequency Among Adults with Chronic Abdominal Pain: Findings From the 2023 US National Health Interview Survey. AEM November 2025. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine in the UK and an evidence-based medicine advocate. She's a seasoned knowledge translator with her PaperinaPic infographics.   Case: You are mid-shift in what feels like the never-ending winter of emergency medicine, and you hear the sigh as your resident picks up the chart of the next patient to be seen. Wondering if the resident requires coffee or support, you ask what is wrong. “I’m...

Date: November 8, 2025 Reference: Millin M, et al., Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries – A NAEMSP Comprehensive Review and Analysis of the Literature, Prehospital Emergency Care, Aug 2025. Guest Skeptic: Clay Odell, BSN, NRP, RN, is a Paramedic Firefighter with Newport (NH) Fire-EMS. He is a past Chief of the NH Bureau of Emergency Medical Services. Previous positions he held are Trauma System Coordinator for the State of NH, Executive Director of Upper Valley Ambulance in Fairlee VT, and a flight crew member at Dartmouth Hitchcock Advanced Response Team. Clay has been a paramedic since 1985 and has been a re...

Date: November 12, 2025 Reference: Taccone et al. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury The TRAIN Randomized Clinical Trial. JAMA 2024 Guest Skeptic: Dr. Alex Weiler is an Emergency Department staff physician in the Peterborough Regional Health Centre and is an associate professor with Queen's University Department of Family Medicine.  This podcast was recorded live at the Kawartha EM Conference in beautiful Peterborough, Ontario.   Case: A 48-year-old woman presents with a sudden, severe headache and brief loss of consciousness. CT/CTA confirms aneurysmal subarachnoid hemorrhage (SAH). She is coiled and admitted to the intensive care unit (ICU) with an...

Date: October 17, 2025 Dr. Kristen Panthagani Guest Skeptic: Dr. Kristen Panthagani is an emergency medicine resident and Yale Emergency Scholar at Yale New Haven Hospital. She’s a physician-scientist, having completed her MD/PhD at Baylor College of Medicine. She’s also well known as a science communicator, creator of You Can Know Things which helps explain science in a way everybody can understand, with an emphasis on addressing health rumors and explaining evidence-based medicine. This SGEM Xtra is inspired by piece in the New England Journal of Medicine titled, Training Health Communicators-The Need for a New Approach. It covers the shif...

Date: October 30, 2025 Reference: Boes et al. Prevalence of violence against health care workers among agitated patients in an urban emergency department. October 2025 AEM Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Case: It's 7:34 pm. You just took a sip of your portable espresso machine coffee from your favourite Batman cup. It's been 34 minutes into your Tuesday overnight shift. Things are a little crazy, but you are proud of yourself for getting your day colleague out on time. Just then, your...

Reference:  Boutin A, et al. Removable Boot vs Casting of Toddler’s Fractures: A Randomized Clinical Trial. JAMA Pediatr. Published April 2025. Date: July 23, 2025 Dr. Andrew Tagg Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder and website lead of Don’t Forget the Bubbles (DFTB). Case: A two-year-old boy presents to your pediatric emergency department (ED) with a limp and refusal to bear weight. His parents aren’t exactly sure what happened. They were at the park and suspected that he might have twisted his leg coming...

Date: October 10, 2025 Guest Skeptic: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers on pain management in the emergency department.  Case: A 37-year-old man presents to the emergency department (ED) with severe right-sided flank pain.  The pain started about eight hours ago as a vague discomfort in his right flank, but it has gotten progressively worse and now is radiating to his groin. Patient reports nausea, an increased urge to urinate and noticing blood in his urine on one occasi...