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Justin Morgenstern

@first10em.bsky.social

https://first10em.com/

220 Posts1528 Follower70 Folgt
Justin Morgenstern @first10em.bsky.social · 2mo ago

Some old articles that never rose to the level of a proper critical appraisal, but still might be interesting for some people

Article dump 2026

One of the downsides of subscribing to more than 50 journal feeds is the huge number of interesting papers that I flag for later, but never find time to fully appraise. I have been clearing some of these old PDFs out of my computer, but I figured that if the titles caught my eye, you might find them interesting as well.

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Justin Morgenstern @first10em.bsky.social · 2mo ago

Should I use antibiotics for strep throat? Do you know why you are actually treating? Short answer: in most places, harms almost certainly outweigh benefits #FOAMed

Should I treat Strep throat?

It should be the easiest patient of the day. It is just a sore throat. The patient is fine. No signs of epiglottitis or deep space infection. They are clearly going home. But you are working with a curious student, and their questions unearth a tremendous amount of uncertainty. How important is it to identify streptococcus at the cause of pharyngitis, and how accurate are our various tools?

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Justin Morgenstern @first10em.bsky.social · 2mo ago

More on invasive PE management The abstract says HI-PEITHO demonstrates benefits - but if you read it yourself, you will probably disagree #FOAMed

HI-PEITHO: More negative data on invasive therapy for higher risk PEs

Only a few weeks have passed since I last wrote about negative trials for invasive therapy in pulmonary embolism. You wouldn’t think I would need to spend more time talking about negative research, but the HI-PETHO trial is different, because it is reported as positive, and some people seem to agree. Let’s review the details so you don’t fall into the same trap. 

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Justin Morgenstern @first10em.bsky.social · 3mo ago

Paxlvoid doesn't work Are you surprised? The PANORAMIC and CanTreatCOVID trials #FOAMed

Paxlovid doesn’t work. Surprise?

Despite incredibly underwhelming evidence from the outset, a massive amount of money was spent (or wasted) on Paxlovid during the COVID pandemic. Some of the issues are endemic to medical science. When we allow companies to test their own products with billions of dollars on the line, the results are horrendously biased from the outset. Unfortunately, despite incredibly weak and biased data, Paxlovid (among many other COVID therapeutics) was pushed forward using the incredibly flawed logic that we should lower our scientific standards during a pandemic.

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Justin Morgenstern @first10em.bsky.social · 3mo ago

The emergency management of a Tet spell (aka a hypercyanotic episode) #FOAMed

The emergency management of a Tet spell (aka a hypercyanotic episode)

A 2 month old boy is brought into the resus room of your community hospital looking completely blue. The mother rather anxiously states that they have been followed at the large pediatric hospital for Tetralogy of Fallot and are awaiting elective repair. Now their child is completely blue, and you were the closest hospital. They were warned about “spells” but can’t remember what to do.

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Casey Parker@broomedocs.bsky.social · 3mo ago

Avalanche Survival in Broome So that is the most ridiculous title that I have ever employed on this blog. Avalanches... Broome.. has Casey finally lost the plot? Well, maybe - but I blame Dr Morgenstern. He sent me an article to review for this month's Journal Club and it forced me down a deep…

Avalanche Survival in Broome

So that is the most ridiculous title that I have ever employed on this blog. Avalanches... Broome.. has Casey finally lost the plot? Well, maybe - but I blame Dr Morgenstern. He sent me an article to review for this month's Journal Club and it forced me down a deep rabbit hole into a snowy academia that I never knew existed.

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Justin Morgenstern @first10em.bsky.social · 3mo ago

Mirtazipine for methamphetamine? This double-blind RCT demonstrates a reduction in methamphetamine use, which is definitely interesting, but the trial is not without problems #FOAMed

Mirtazipine for methamphetamine? (McKetin 2026)

Addictions are incredibly challenging to treat in the emergency department, although hopefully everyone has accumulated a few wins with suboxone over recent years, and so maintains at least a modicum of optimism. Methamphetamine is much less common around me, but the primary drug of abuse in many areas of the world, and, unlike opioids, methamphetamine addiction does not have approved pharmacotherapeutic options.

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Justin Morgenstern @first10em.bsky.social · 4mo ago

2 new RCTs looking at interventional approaches to pulmonary embolism Do you have access to these tools? Should you use them? #FOAMed

Higher risk PE management updates (The STRATIFY and STORM-PE trials)

I have written fairly extensively about the management of high risk PE. Despite their growing popularity, I have remained quite skeptical of catheter directed therapies. If you are going to give a thrombolytic, my sense is that it is going to be just as effective if given through a peripheral vein, and that fancy catheters add nothing but risk and cost.

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Justin Morgenstern @first10em.bsky.social · 4mo ago

Yet again, treating numbers doesn't help This time, we have the first RCT looking at blood pressure targets in spinal cord injury

Blood pressure targets in spinal cord injury (Treat patients not numbers)

Although guidelines have long suggested higher blood pressure targets in spinal cord injury, that recommendation has never been based on high quality evidence. (Walters 2013; Sanchez 2020) (This is the first ever RCT.) We have a bad habit of treating numbers in medicine, and often making things worse. (Remember the recent paper discussing worse outcomes when we lower blood pressure in ICH, for example…

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Justin Morgenstern @first10em.bsky.social · 4mo ago

The first RCT looking at whole blood in trauma is out - and unsurprisingly, there is no benefit #FOAMed

No benefit from whole blood – the SWiFT trial

At this point, most people in the emergency medicine and critical care worlds just assume that balanced (ie, 1:1:1) transfusion is a proven intervention, and the focus has mostly moved on the the potential of whole blood. I am in an almost nonexistent minority when I argue that balanced transfusion is certainly not proven, and may even turn out to be harmful, but that is what the data seems to say.

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Justin Morgenstern @first10em.bsky.social · 5mo ago

Another collection of interesting emergency medicine articles #FOAMed

Research Roundup – March 2026

Classic medicine: running high cost RCTs that are too small to give real answers Préterre C, Gaultier A, Obadia M, Vignal C, Mourand I, Plat J, Sablot D, Gaudron M, Rodier G, Godeneche G, Urbanczyk C, Marc G, Massardier E, Adam S, Boulanger M, Marcel S, Mechtouff L, Ronzière T, Calvière L, Godard-Ducceschi S, Barbin L, Lebranchu P, Guillon B; THEIA collaborators.

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Lars Mølgaard Saxhaug@load-dependent.eurosky.social · 5mo ago

One point that isn't mentioned here but too often forgotten when noradrenaline seemingly isn't working: Are you actually using a representative blood pressure? Not so rare that a better (more central or better line) fixes the problem. Look at the whole patient, not just a number! #emimcc #cccsky

Justin Morgenstern @first10em.bsky.social · 5mo ago

Norepinephrine isn't work - now what?? A #FOAMed guide to the assessment and management of refractory shock