#ICEM2025 May 25th Recap
- Shahbaz Syed
- May 25
- 32 min read
Updated: May 28
ICEM 2025 Daily Recap: Sunday, May 25 – A Day of Innovation and Connection
Welcome to our first daily recap from ICEM 2025 in Montréal! Sunday was a dynamic start to the conference, filled with insightful sessions, groundbreaking discussions, and vibrant networking opportunities. Here’s a structured overview of the day’s highlights:
Disclaimer: Much of the content in this post was captured live or based on material shared with us. If any speakers notice inaccuracies, please reach out to the social media team. We also acknowledge that not all of the excellent content from the conference could be included.
🏛️ Opening Ceremony
Opening ICEM2025, a heartfelt tribute was paid to the Kanien’kehá:ka (Mohawk Nation), the traditional custodians of the lands on which the conference is being held. Performed by Ka'nasohon Elder Kevin Deer. Attendees were invited to reflect on the enduring presence and cultural significance of the Kanien’kehá:ka people. This powerful moment served not only as a recognition of the past, but as a commitment to walk together in the spirit of truth, reconciliation, and partnership.
Dr. Aimee Kernick welcomed us to the conference on behalf of the Canadian Association of Emergency Physicians (CAEP) - hosting ICEM for the first time in more than a decade.
🌟 Plenary Session: “Dare to Explore”
Kicking off the conference with inspiration that’s truly out of this world, Dr. David Saint-Jacques joins us live from NASA’s Johnson Space Center in Houston, Texas. A physician, engineer, astrophysicist, and Canadian Space Agency astronaut, Dr. Saint-Jacques brings a unique perspective shaped by years of exploration—both on Earth and beyond. He’s best known for his 204-day mission aboard the International Space Station in 2018–2019, the longest Canadian spaceflight to date. With experience spanning remote Arctic medicine to zero-gravity spacewalks, he opens the conference with a talk aptly titled “Dare to Explore”—challenging us to push boundaries, embrace the unknown, and lead with curiosity.
As he addressed us from the heart of NASA’s operations, Dr. Saint-Jacques reminded us of what’s possible when science, teamwork, and human curiosity align.
A Physician Among the Stars
Dr. Saint-Jacques is no stranger to remote medicine. He described his early career working as the sole physician in a small northern community, managing whatever came through the clinic doors. “Being aboard the ISS can feel very similar,” he noted. “You’re one of a small crew, working together to solve problems, often improvising—McGyver-style.”
He didn’t set out to be an astronaut through medicine, though. That path began much earlier: as a young boy dreaming about the cosmos. “I remember seeing a picture of Earth from the Moon and wondering—who took that? That moment changed my life.” From that seed of curiosity, he pursued engineering, medicine, and ultimately spaceflight, culminating in his 204-day mission aboard the International Space Station.
During his mission, he became the fourth Canadian to perform a spacewalk and the first Canadian to operate the Canadarm2 on the ISS—an iconic symbol of Canadian ingenuity.
Life on the ISS: Medicine, Maintenance, and Perspective
Dr. Saint-Jacques spoke passionately about the ISS as a marvel of technology—“the most complicated machine humans have ever built.” Half of it is essentially a giant life-support machine, sustaining human life in the vacuum of space. The other half? Science experiments and health research - often using the astronauts themselves as study subjects.
“Going to space is cool,” he said with a smile, “but it’s bad for your health.” Weightlessness affects every body system, making astronauts ideal models for studying disease processes in otherwise healthy individuals. Much of that research, he emphasized, is led by Canadian teams.
He also spoke movingly about the collaborative spirit of the ISS, calling it “one of the last bridges humanity wants to keep open at all costs.” Despite conflicts on Earth, nations continue to work together in orbit - proof, he said, that “when we choose to cooperate, we can do incredible things.”
But perhaps most striking was the shift in perspective he experienced while off-world:
“Earth is a life-sustaining machine for billions of us. The ISS keeps a handful of astronauts alive in the deadly vacuum of space—and we’re in awe of that. But the Earth does this at a massive scale. The atmosphere is our helmet.”
It’s a perspective that stays with him still, one that reframes our planet as a shared, fragile spacecraft—one we must protect together.
Coming Home, and Looking Forward
Returning to Earth wasn’t gentle. “You crash land, then are pulled from the capsule by a rescue team. Gravity hits hard.” After weeks of rehab, he slowly regained his balance and strength. “I felt useless at first… but eventually I was ready to be an Earthling again.”
Despite the trials, it’s clear his time in space brought him closer to his loved ones. “It’s like a long business trip. I cherished every FaceTime I got with my family.”
As for the future, Saint-Jacques shared his excitement for Artemis II, the upcoming crewed mission to orbit the Moon, which will include Canadian astronaut Jeremy Hansen. Looking ahead to Mars, he highlighted how medical autonomy - especially for long-duration missions - will be a crucial challenge. Physicians, he emphasized, will continue to play a central role in space exploration.
A Final Glimpse from Above
Dr. Saint-Jacques closed with a series of breathtaking images of Earth taken from the cupola of the ISS—reminders of both our smallness and our shared home.
“When you zoom out, you realize how much we’re in the middle of nowhere, floating together. It makes you want to protect your family—and this planet.”
🔍 Morning Concurrent Tracks
Digital EM and Tech Innovation: Sessions explored the integration of digital tools in emergency settings, highlighting advancements in telemedicine, electronic health records, and AI-driven diagnostics.
Dr. Kendall Ho on Implementing Medical Technology in the Emergency Department
AI scribes are being developed to detect diagnostic errors from emergency physicians and request changes to management plans or investigations
AI diagnostic technologies are booming and are now able to estimate a pro-BNP through a stethoscope-like probe
Are we allowing AI to take over the emergency provider's job?
Dr. Erik Blutinger on the Cost and Value of AI in Emergency Medicine
The rapid rise of telemedicine has significantly reduced the burden on emergency departments, decreasing the number of patients requiring in-person care. While this shift offers clear benefits for system efficiency and accessibility, it also presents challenges for emergency medicine stakeholders who are now seeing a decline in patient volumes. However, the promise of virtual care is not universal — limited broadband access in some regions continues to restrict equitable use of telehealth services. Additionally, growing concerns around artificial intelligence are emerging among healthcare providers, including fears about erosion of clinical autonomy, the role of private tech companies in handling sensitive patient data, and the potential for political interference in clinical decision-making.
Dr. Tom Hughes and Dr. Ben Bloom on Value-Based Emergency Healthcare
The world is changing — with fewer trauma cases and evolving models of care, we must ask ourselves: what value do emergency physicians bring, and what will our role be in 50 or even 500 years? One significant shift is the sharp decline in patients referred directly to the emergency department by primary care providers, altering the traditional pathways of acute care. At the same time, emergency physicians often manage patients who present with undifferentiated symptoms that do not lead to a definitive diagnosis — a common and acceptable outcome in our field. This raises an important question: how do we demonstrate the value of emergency medicine when our work is focused on risk stratification, stabilization, and ruling out life-threatening illness rather than providing a final answer?
Dr. Goksu Bozdereli Berikol on hyperprecision in Emergency Medicine:
The current focus in emergency medicine is shifting away from generalized, population-level early warning systems and clinical decision rules (CDRs) toward a highly personalized, patient-specific approach.
Emerging technologies, including AI, aim to deliver dynamic and precise recommendations tailored to the individual, rather than relying solely on static protocols.
For example, current guidelines on the use of P2Y12 inhibitors in acute coronary syndrome (ACS) do not account for genetic or individual variability in patient response to these medications.
AI has the potential to assess data in real time and generate personalized management recommendations at the bedside, enhancing precision and safety in emergency care.
Drugs and Doses: Toxicology and Addiction: Experts discussed current trends in substance use, overdose management, and the role of emergency departments in addressing addiction.
Dr. David Wood on Emerging Drugs of Abuse:
We’re seeing a surge in novel psychoactive substances — and their toxic effects are landing in our EDs.
🚨 Trends to know:
• Synthetic cannabinoids like Spice, K2, and K1 → renal & cardiovascular toxicity
• Synthetic cathinones (e.g. mephedrone) → sold as “bath salts,” often purchased legally
• Potent opioids: Fentanyl, Nitazines → require higher doses of naloxone
• Xylazine contamination → causes profound sedation, bradycardia, hypotension, and ulcerative skin lesions
⚠️ Stay sharp. These aren’t the drugs we trained for — but they’re the ones we’re facing now.
Dr. Robert Hoffman on the Growing Burden of Cannabis Use Disorder in the ED:
Cannabis isn’t the benign substance it’s often made out to be — especially in the ED.
🧠 Cognitive risks:
• Prenatal exposure → impaired development
• Adolescents → lower grades, decreased graduation rates
• ED visits linked to increased dementia risk
❤️ Cardiovascular:
• Arrhythmias (especially A Fib), strokes → emerging signals
• MI and aSAH less clear but still present
🚗 Trauma:
• THC frequently detected in injured drivers
😔 Mental health:
• Cannabis use disorder linked to self-harm, overdose, and all-cause mortality
🧸 And don’t forget: Potency is up. Pediatric ingestions (gummies especially) are a rising concern.
EMS: Presentations focused on pre-hospital care innovations, including community paramedicine programs and strategies for improving response times.
Dr. Shelden Cheskes on dual sequential defibrillation:
Dr. Qasim Zaffer on Hemorrhage Control in Mass Casualty Events:
In mass casualty incidents (MCIs), hemorrhage remains a leading cause of preventable death. Closing the gap between injury and intervention — particularly in terrorist incidents — requires a shift in strategy: bringing care closer to the point of injury, simplifying triage, and empowering trained lay responders to act during the critical early minutes.
Terrorist attacks continue to occur globally, with hemorrhage identified as a recurring, preventable cause of death in after-action reviews.
Delivering care closer to the point of injury is limited by safety risks for prehospital providers.
Tactical teams must either:
Deliver hemorrhage control interventions themselves within the warm zone, or
Facilitate rapid access and protection for medical personnel entering high-risk areas.
Triage in MCIs must be streamlined and intuitive, recognizing the high cognitive load and stress responders face during chaotic scenes.
A critical window often exists between the incident and the arrival of trained responders — a period frequently overlooked in planning but responsible for avoidable mortality.
Empowering Immediate Responders:
Laypeople who are already on scene or nearby — known as immediate responders — can provide life-saving hemorrhage control before EMS arrival.
Public training programs are essential:
Stop the Bleed (American College of Surgeons)
Until Help Arrives (ACEP)
Co-locating bleeding control kits with AEDs ensures immediate access to tourniquets, hemostatic agents, and gauze for public use during high-threat events.
To reduce preventable death in mass casualty incidents, hemorrhage control must become everyone’s responsibility — not just trained responders. By embracing tactical medical support, public education, and better access to bleeding kits, we can shorten the time to intervention and save lives.
Dr. Lysianne Hamel on staying afloat: updates in drowning care:
Drowning is a process for which there are 2 outcomes: FATAL (Dead) or NON-FATAL (Alive). Yes ! Someone can survive a drowning, according to current international standardized definitions of drowning (Fatal vs non-fatal, with or without morbidities).
The Drowning Chain of Survival focuses on the prevention of drowning, early recognition of a drowning individual, and considerations for safe rescue and resuscitation. (*Rescuer-Safety First !)
The mainstay of drowning care and management is to reverse hypoxia. However, there is a lack of strong evidence-based recommendations on the management of drowning, and many researches and knowledge gaps to be filled.
Geriatric Emergency Medicine: Attendees examined best practices for managing the complex needs of older adults in emergency settings.
Dr. Juliana Poh on Strategies to Prevent ED Bouncebacks in Elderly Patients
It can be very difficult to have Advanced Care conversations in the ED, especially when these are not culturally acceptable. Take advantage of interdisciplinary colleagues in palliative care, geriatrics, nursing, social work, etc. to ensure we do not avoid these conversations forever.
Hard Core EM: Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Dr. Amal Mattu on the Myth of Diuretics in Acute Heart Failure
Dr. Amal Mattu never disappoints. In this high-impact plenary session, he dismantled one of emergency medicine’s long-held assumptions: that early diuresis is the cornerstone of managing acute heart failure. With clarity, evidence, and clinical wisdom, he walked us through why it’s time to rethink that reflex - and what should guide our approach instead.
The Case That Starts It All
A classic case: a 65-year-old man presenting with an acute heart failure exacerbation. We’ve all seen it—severe dyspnea, rales, hypertension, hypoxia. The usual reflex? Oxygen, furosemide, chest x-ray, labs, and maybe a bit of nitroglycerin.
But here’s the question Dr. Mattu posed: What’s the optimal treatment in the first 5–10 minutes?
His answer was clear: non-invasive ventilation. He emphasized that most emergency physicians are already comfortable here, and it’s often the single most impactful intervention we make early on.
But what comes next? That’s where things get interesting.
It’s Not About Fluid Removal—It’s About Redistribution
Dr. Mattu challenged a key assumption: that pulmonary edema always equals volume overload. Up to 50% of patients with cardiogenic pulmonary edema are not fluid overloaded. They’re often euvolemic or even hypovolemic. Their symptoms aren’t due to “too much fluid” but fluid in the wrong place—the lungs. The real issue is preload and afterload mismatch, not necessarily volume excess.
Furosemide is excellent at removing total body water, but that’s not the acute problem. What these patients need is rapid fluid redistribution out of the pulmonary vasculature, and that means aggressive preload and afterload reduction.
So, What’s the Problem with Early Furosemide?
In a healthy person, IV furosemide prompts brisk diuresis. But in the acutely unwell, the response is delayed, sometimes by hours. What often happens next? We re-dose, chasing a urine output that hasn’t yet materialized, and by the time the patient starts to diurese, we’ve overshot. Dr. Mattu pointed out that many patients end up profoundly hypovolemic 24–48 hours later, especially in the CCU.
Why the delay? The key lies in afterload. These patients are vasoconstricted, and renal perfusion is often impaired. That means the furosemide we give isn’t reaching the kidneys effectively—and we see little benefit upfront.
The Venodilation Myth
Many of us were taught that furosemide provides immediate venodilation, improving preload. But as Dr. Mattu emphasized, this is based on poor-quality data. The real effect? Furosemide may increase heart rate and systemic vascular resistance, and even decrease stroke volume—worsening hemodynamics before any benefit appears. These changes reverse only after the patient has adequately diuresed.
In short, giving furosemide too early in acute pulmonary edema may be ineffective at best—and potentially harmful at worst.
Perfuse the Kidneys First
The takeaway? Optimize afterload reduction before giving diuretics. Until the kidney is perfused, the diuretic isn’t doing its job—and may be making things worse.
This is why ACEP’s clinical policy on acute heart failure syndromes no longer specifies a precise timing for furosemide. It’s not a race to get the drug in—it’s a race to stabilize the hemodynamics first.
The Mattu Sequence: How to Manage Acute Pulmonary Edema
Going back to the case, Dr. Mattu laid out his approach in clear, practical steps:
Non-invasive ventilation – CPAP or BiPAP as early as possible.
Sublingual nitroglycerin – 0.6–0.8 mg every 5 minutes, up to 3–4 doses.
High-dose IV nitroglycerin – Start the infusion early for effective afterload reduction.
Furosemide – Administer after the above, typically around 30 minutes into management, once perfusion improves.
Dr. Mattu's slides will be available here for the next month:
lectures.umem.org/Montreal-ICEM
Dr. Kerstein de Wit on acute PE:
PERT teams can help standardize decision-making for high and intermediate risk PE
Advanced therapies include catheter-directed therapy, systemic thrombolysis, surgical embolectomy, and ECMO
AVOID endotracheal intubation in patients with intermediate-high and high risk PE
NEVER delay anticoagulation
Prescribe low molecular weight heparin rather than intravenous unfractionated heparin for intermediate risk PE.
Most patients can have a direct oral anticoagulant (except those with luminal GI tumours, recent GI bleeds, pregnancy, breastfeeding, or co-prescribed liver enzyme inducer drugs).
Risk stratify using ESSC criteria: low/intermediate/high risk (don’t use ‘massive’/’submassive’)
🟢 Low-Risk PE
Hemodynamically stable
No RV dysfunction
Normal biomarkers
May be eligible for early discharge or outpatient management if no other contraindications
➡️ Stratification tools like PESI or sPESI help confirm low-risk status.
🟠 Intermediate-Risk PE (Submassive PE)
Definition: Hemodynamically stable but with evidence of RV dysfunction and/or elevated cardiac biomarkers
Split further into:
🔸 Intermediate–High Risk:
RV dysfunction on imaging (e.g., echocardiogram or CT) AND
Elevated cardiac biomarkers (troponin, BNP/NT-proBNP)
➡️ Close monitoring; consider escalation if clinical deterioration.
🔸 Intermediate–Low Risk:
Either RV dysfunction or elevated biomarkers, but not both
➡️ Anticoagulation; monitor closely but generally no need for aggressive interventions.
🔴 High-Risk PE (Massive PE)
Definition: Hemodynamically unstable PE
Systolic BP < 90 mmHg for >15 min
OR need for vasopressors to maintain BP
OR signs of shock (altered mental status, cold/clammy skin, oliguria, etc.)
➡️ Immediate reperfusion therapy (typically systemic thrombolysis) is indicated.
In low risk PE patients use Hestia, sPESI or implicit judgement to decide on discharge home
Always ensure rapid, reliable follow up if discharging PE patient home
Dr. David Carr on 20 years of Tricks of the Trade
This isn’t a list pulled from guidelines or meta-analyses — it’s pearls from the pit. After 20 years on the frontlines, these are the tricks, tips, and hacks that have stuck with me. Some are evidence-based. Some are urologist-texted. All are real-world useful.
1. Elderly Trial of Void Hack
When planning a trial of void after catheterization in the elderly, don’t just pull the Foley and hope for the best.
Instead, instill 300cc of sterile fluid, clamp it, then remove the catheter. The bladder’s already full — no need to wait hours for hydration.
If it fails, just reinsert.
2. Sexual Expulsive Therapy for Renal Colic
Flomax is an expensive Tic Tac.
In men, sexual release increases passage rates of distal ureteric stones via prostatic urethral relaxation. Worth the conversation.
3. Priapism and Stair Climbs
Got a patient with low-flow priapism?
Try 2–5 minutes of stair climbing or brisk walking to redirect blood flow before escalating.
✅ Evidence-backed: Study link
4. PoCUS for Testicular Torsion
A linear probe + Doppler can help make the call.
Look for asymmetry in flow. If one side is dark, you’re probably dealing with torsion.
Use this as a tool, not a crutch, when calling urology.
5. "Broken" Tonopen Trick
In high-suspicion angle-closure glaucoma, and no tonopen in sight?
Yes, we’ve all “accidentally” claimed the tonopen is broken.
Gently palpate closed eyelids. A rock-hard globe on one side? That’s your clue.
6. Epistaxis Burrito
Hate nosebleeds?
Try the Surgicel burrito:
Wrap gelfoam in Surgicel, soak in TXA or lidocaine, then pack it. Tamponade + procoagulant + comfort.
7. Right Nostril NGT Trick
According to Simon Carley’s study, right-sided NG tube attempts have 83% success, compared to 47% blind insertion.
Why? Right nostril anatomy is often more favorable.
8. Nursemaid’s Elbow Reduction: Supination is Out
Supination/flexion works 69% of the time.
Hyperpronation works 94%.
Flex the elbow and sharply pronate — much more reliable.
9. The Forgotten Carpal Tunnel Test
Forget Phalen and Tinel. Try the hand elevation test (arm raised for 1–2 minutes).
Much better sensitivity and specificity — and more practical in the ED.
10. Nailbed Injuries: Just Glue It
If a nail pops off with trauma, don’t throw it out.
Place it back under the cuticle and secure with tissue adhesive (Dermabond).
Acts as a natural splint while the nail bed heals.
11. Mandolin Finger? Glue It
For clean, superficial digital lacerations (think mandolin injuries):
Dip in topical lidocaine
Apply a tourniquet, dry the wound
Close with Dermabond
12. Pediatric Hair Tourniquet
Toe looks red and swollen? Suspect a hair tourniquet.?
Apply Nair hair remover. No cutting required.
13. Bells Palsy vs Botox
Hard to assess forehead sparing with prior Botox?
Try the sugar test: place sugar on the anterior tongue.
CN VII innervates the anterior 2/3 — if they taste on one side and not the other, you’ve confirmed a facial nerve palsy.
14. DKA and ETCO₂
Quick acid-base rule with end-tidal CO₂:
ETCO₂ | Interpretation |
<21 | 100% sensitive for DKA |
<26 | 96% sensitive |
>35 | If BG >26, rules out DKA |
15. No Urine? Use Blood for bHCG
Need a pregnancy test but can’t get urine?
Use a drop of blood on a urine HCG strip.
Same antigen — same result.
16. Off-Label Wisdom: Carr’s Cocktail of Tricks
Antiemetic? Alcohol prep pad under the nose - works fast and great in pregnancy.
Gastro? Half apple juice/half water, or G2. Fluids matter.
Cannabinoid hyperemesis? IV Haldol 0.05mg/kg SLOWLY.
Gout? Colchicine 1.2mg, then 0.6mg one hour later — but only if <12h since onset.
Trigeminal neuralgia? IV Dilantin 10mg/kg for acute flare.
Esophageal food bolus? Try nitroglycerin (topical or inhaled).
Fecal disimpaction? Instill Urojet (lidocaine jelly) first.
Ketamine analgesia? 0.3 mg/kg IV over 15 mins. Excellent opioid alternative.
Cephalexin too frequent? Use Cefadroxil once daily. Same spectrum.
Difficult conversations with radiology?
It’s 4 a.m. You need a CTA for dissection, and the radiologist pushes back.
Try this:
“I’m sure you can appreciate the consequences if both of us miss this.”
You’re not just ordering a scan — you’re sharing the risk.
ED in the System: Healthcare Delivery and Wellness: Discussions addressed systemic challenges in emergency care delivery and strategies for clinician wellness.
Dr. Daniel Kollek and Dr. Susan Snyder on improv comedy and emergency medicine:
They paralleled that there key components of improv comedy that are very useful in Emergency Medicine (LACE):
● Listening under pressure (improve listening skills)
● Acknowledging and accepting input (aid agenda shifting)
● Committing to a decision (help being decisive)
● Extending a bit of information (make your responses clear)
The benefits of improv comedy cross over into communication skills, and LACE is to comedy what ATLS is to trauma.
🔍 Afternoon Concurrent Tracks 1
Drugs and Doses: Toxicology and Addiction: Experts discussed current trends in substance use, overdose management, and the role of emergency departments in addressing addiction.
Dr. Craig Berlinger on Managing Organophosphate Poisoning
In Johannesburg, up to 80% of non-fatal suicide attempts involve organophosphates — and over half of these patients require intubation or ICU-level care.
💡 Key Takeaways:
1️⃣ Recognize & treat the toxidrome early
• Muscarinic symptoms (SLUDGE, killer B’s) → respond to aggressive atropine (rapid doubling)
2️⃣ Nicotinic toxicity? Consider IV magnesium
3️⃣ Gastric lavage may have a role in select cases
4️⃣ FFP might help — evidence is limited
5️⃣ Hemoperfusion has shown promise in some settings
🧠 Remember: These aren’t just agricultural toxins — they’re increasingly part of urban overdose patterns.
Dr. Venkat Kotamraju on the Brady Bunch: Cardiotoxic Overdoses
Bradycardia from cardiotoxic overdoses? Think BBs, CCBs, Digoxin, Clonidine — and look for the clinical clues that differentiate them.
🩺 Key Pearls:
• Beta-blockers
• Propranolol = Na⁺ channel blocker → mimics TCA on ECG
• Sotalol → watch for Torsades
• BBs = ↓ glucose & ↓ LOC
• Calcium channel blockers
• CCBs = ↑ glucose & normal LOC
• Amlodipine = “pipe” issue, Verapamil = “pump” failure
• Insulin resistance is a key feature
💉 Hyperinsulinemia Euglycemic Therapy
• 1U/kg bolus + 1U/kg/hr insulin infusion
• Monitor glucose & potassium
🧪 Other options: Intralipid, ECMO, pacing, methylene blue
💊 Digoxin → look for GI or neuro symptoms, biventricular VT → treat with Digibind
🧠 Clonidine → opioid mimic, may reverse with naloxone
Dr. Sophie Gosselin on GI Decontamination in 2025
GI decontamination isn’t dead — it’s just evolved. The key is balancing risk vs benefit in the modern tox landscape.
🧠 Clinical Pearls:
• Ask: Is the toxin absorbable? Is it lethal? Are there risks of aspiration/seizure?
• Toxin gastroparesis: Large ingestions may delay gastric emptying
• Pharmacobezoars: May benefit from decontamination
• Activated Charcoal (AC): Still useful >1 hr post-ingestion in select cases
– SR drugs, ongoing absorption, slowed GI motility
• NG tube caution: Avoid AC via NG if no ET tube (aspiration risk)
– Consider only in severe toxicity where benefits outweigh risks
📌 AC indications: Early/life-threatening ingestions, pharmacobezoars, toxic gastroparesis
📌 Gastric lavage: Very early & lethal ingestions only
Disaster Emergency Medicine: This track explores the evolving challenges of mass casualty response, resource-limited care, and health system resilience during large-scale emergencies.
Dr. Daniel Kollek on Responding to a Multisite Casualty Event
The events of October 7th in Israel underscored that disaster response must be adaptive, integrated, and deeply rooted in public preparedness. Emergency systems must be designed not for the routine, but for the extraordinary — and that starts long before the first ambulance is dispatched.
EMS in Crisis: Designed to Flex
Dr. Daniel Kollek described how Israel’s modular EMS system responded to a large-scale, multisite mass casualty event. Key components:
Modular EMS structure enables scalable responses across urban and rural regions.
Nationwide real-time data access allows coordination between dispatch, hospitals, and field providers.
Dispatchers have visibility over all available resources — not just ambulances, but:
Police
Civilian volunteers
AEDs and epinephrine auto-injectors
Medical supply caches
“EMS does not operate in a vacuum — the system must function in extreme, non-routine conditions.”
Hospitals are built as bomb shelters, designed to operate through crisis.
During the October 7th events, every available ambulance was activated, and emergency upstaffing protocols were implemented in real time.
Mass casualty events don’t follow playbooks. They overwhelm systems designed for the everyday. Kollek emphasized the need for non-routine system thinking:
Systems must anticipate failure points and build in redundancy.
Protocols must remain adaptable to dynamically evolving threats.
Effective communication between agencies — and with the public — is essential to limit chaos.
Public Training: The First Pillar of Readiness
Disaster readiness begins long before a crisis — with the public.
Widespread civilian training programs divide the country into zones, each with tailored preparedness objectives.
The focus is on first actions:
Bleeding control
Safe sheltering
Coordinated EMS reporting
Public Safety Messaging:
The Public Safety Advisory System (PSAS) offers targeted alerts and instructions, including:
How to report missile impacts directly to EMS
What constitutes a true emergency
When reassurance is the best medicine
Public anxiety can drive surges in unnecessary 911 calls. Targeted messaging helps reduce distress, ensuring emergency lines remain open for life-threatening needs.
Final Thoughts
Disasters don’t wait for systems to catch up — they stress every link from dispatch to hospital, from citizen to state.
The lessons from October 7th are clear:
Prepare the public first
Design systems for the non-routine
Empower dispatchers with real-time, cross-sector visibility
Ensure hospitals and EMS infrastructure are crisis-ready
When the worst happens, success isn’t about perfection — it’s about preparation.
Dr. Lai Pei-Fang on Hualien DMAT Mobile Application for Brdiging Disaster Response with Digital Innovation
Disaster response is about speed, coordination, and data. The iDMAT mobile application, developed in Taiwan by the Hualien Disaster Medical Assistance Team (DMAT), provides a blueprint for how digital tools can transform emergency response — from triage to treatment, and field to hospital.
Context: Disaster in a High-Risk Region
Taiwan sits squarely on the Ring of Fire, making it highly vulnerable to earthquakes and typhoons. The eastern region of Hualien is no stranger to mass casualty incidents, including:
2018 Hualien Earthquake
2021 Train Derailment
2024 Earthquake
These events have frequently left Hualien isolated, with limited infrastructure and communication, underscoring the need for resilient, mobile-first disaster response tools.
From Simple Check-In to Full System Integration
Following the 2018 earthquake, the Hualien DMAT (Disaster Medical Assistance Team) was established. Their initial tool was a basic patient check-in app — but necessity drove innovation.
Today, that app has evolved into iDMAT, a comprehensive mobile disaster management platform with wide-reaching functionality:
Real-time disaster site reporting
Dynamic team deployment coordination
Operates as a digital Emergency Operations Center (EOC)
On-site medical assessments with digitized documentation
QR code wristbands for triage tracking
Seamless Data Flow: From Field to Hospital
One of iDMAT’s key strengths lies in its ability to bridge field care with hospital systems:
Patient data integrates directly into hospital information systems when available
For hospitals without direct integration, cloud-based access provides essential patient data
Enables continuity of care from the disaster zone to the emergency department
📱 A mobile app that functions as a trauma bay whiteboard, command center, and EMR — all in one.
Final Thoughts
As natural disasters increase in frequency and complexity, emergency medicine must evolve alongside them. The Hualien iDMAT app offers a clear example of how mobile-first solutions can:
Improve triage accuracy
Enhance team coordination
Ensure timely documentation and hospital handoff
It’s a model with global implications, particularly for resource-limited, disaster-prone regions.
Dr. Jared Bly on the Zombies are Coming! (Click to read more)
Geriatric Emergency Medicine: Attendees examined best practices for managing the complex needs of older adults in emergency settings.
Dr. Christina Shenvi on Social Drivers of Health in Older Adults in the ED (Click here to read)
Dr. Vu Kiet Tran on Ageism in Emergency Medicine
Always address older patients with respect, using appropriate titles and preferred names.
Speak directly to the patient, not to their family or caregiver — unless the patient explicitly asks you to do otherwise.
Recognize that the emergency department is a moment of vulnerability and may not reflect the patient’s baseline level of function or independence.
Be mindful of systemic factors in your environment that may negatively impact older adults:
Institutional policies that unintentionally disadvantage older patients
Behaviors or assumptions that reinforce ageist stereotypes
Hard Core EM: Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Dr. Katrina Hurley on Bouncing Back When it All Goes Wrong:
We all carry hard cases — but we don’t have to carry them alone. Recovery from grief, error, and trauma requires honesty, authenticity, and community. Shine a light on your experience. Keep it real. Rise together.
A Case That Stays With You
The night shift begins with handover: a 2-year-old in status epilepticus. Ex-prem. Stabilized with benzodiazepines and Dilantin. There’s a question about the VP shunt. “It’s fine,” comes the answer. The child is sleeping.
A few hours later, he deteriorates. Shunt failure. Despite efforts, he passes away.
During resuscitation, the mother says:“This was your fault. He was over-sedated.”
Dr. Katrina Hurley still carries that case — not because she was at fault, but because she knows she didn’t do her best.
When it All Goes Wrong
“Going wrong” in medicine can mean many things:
An unexpected death
A diagnostic miss
A lawsuit
A communication failure
A breakdown in systems or teams
While the causes vary, the emotional impact often overlaps — guilt, anger, numbness, fear, shame, or even indifference. And all of this unfolds while we continue to care for patients, often pretending we’re okay.
“It’s stressful to keep working while hiding emotional distress from other patients — and from ourselves.”
The stories we tell ourselves shape our healing. Some become traps:
“I should have done more.”
“I failed.”
“I’m not cut out for this.”
But by naming, examining, and reframing those stories, we begin to free ourselves.
The antidote isn’t detachment — it’s authenticity.
When recovery doesn’t happen, the consequences ripple outward.
Some leave the profession altogether — a growing trend among younger emergency physicians, though the reasons remain unclear.
Others stay — but burn out.
Physicians, especially women, are at higher risk of suicide than the general population.
This isn’t weakness — it’s a reflection of how medicine has failed to support its healers.
Burnout is often defined as a triad of:
Emotional exhaustion
Depersonalization
A reduced sense of personal accomplishment
But perhaps more simply, it’s the shift from thriving to surviving.
A 2019 systematic review found a strong association between burnout and medical error, reinforcing what we already know: clinicians in distress make less safe decisions, and feel less connected to their work.
A Mental Health Continuum
Recovery isn’t binary — it’s a continuum. Here’s one way to frame it:
Fragile
“If I drop it, it breaks.”
A fixed mindset. Needs perfection. Falls apart under pressure.
Resilient
“I bounce back.”
Like a trampoline — capable of recovery, even under repeated strain.
Anti-Fragile
“I get stronger under stress.”
Forged in fire. Not just surviving hard things — made by them.
Keeping It Real: The Power of Authenticity
Authenticity means showing up with your true thoughts, emotions, and values — not as performance, but as alignment. It’s not about vulnerability for its own sake — it’s about being honest with yourself, and others.
Why authenticity matters:
Builds resilience
Fuels compassion
Strengthens trust with patients and peers
Promotes purpose and meaning
Protects against burnout and depression
“Keeping it real” isn’t a weakness — it’s protection.
When things go wrong, healing takes more than time. It takes awareness, courage, and connection.
Key Messages:
Shine a light in the dark places
Keep it real
Rise together
Dr. Christine Hanna on Antibiotics in Diverticulitis:
Routine antibiotics are no longer recommended for patients with CT-confirmed acute uncomplicated diverticulitis, provided there are no high-risk features and outpatient follow-up is reliable. This shift, supported by multiple trials and international guidelines, reflects a growing confidence in selective, conservative management.
Today, emerging evidence challenges this default, especially in uncomplicated cases.
On CT imaging, diverticulitis is considered uncomplicated if:
There is colonic wall thickening, pericolic fat stranding, or diverticula,
Without evidence of:
Abscess
Perforation
Fistula
Obstruction
Free air or free fluid
(Reference: American College of Radiology [ACR] Appropriateness Criteria; Danish DIVERT trial, AVOD trial)
Who Is Considered High-Risk?
Antibiotics may still be appropriate in patients with any of the following high-risk features:
Immunocompromised status (e.g., transplant, chemotherapy, HIV/AIDS)
Significant comorbidities (e.g., diabetes with poor control, advanced renal/liver disease)
Systemic signs of infection (e.g., sepsis, fever >38.5°C, leukocytosis)
Inability to tolerate oral intake
Social or logistical barriers to outpatient care (e.g., homelessness, no access to follow-up)
If your patient presents with suspected diverticulitis and a CT confirms uncomplicated disease, consider the following:
✅ No high-risk features
✅ Clinically well-appearing and tolerating oral intake
✅ Access to follow-up (PCP, GI, or return-to-ED plan)
In this case, antibiotics are likely unnecessary — and you’re aligned with evidence-based best practice.
Dr. Paul Atkinson on 'Seeing is Believing' with PoCUS (click to read)
ED in the System: Healthcare Delivery and Wellness: Discussions addressed systemic challenges in emergency care delivery and strategies for clinician wellness.
Dr. Louise Rang on Wellness, What Works:
In the current climate of emergency medicine, wellness initiatives can feel impossible to implement — but they’re more essential than ever. This session highlighted that effective programs share three key principles:
Ground-up needs assessment
Shared ownership of the future
Fostering real human connection
Here are three inspiring wellness initiatives to help guide your next steps.
1. Clinical Adaptation Policies for Senior Physicians
Dr. Riyad Abu-Laban – University of British Columbia
Emergency medicine is a demanding career, and we must support longevity in our colleagues.
Dr. Abu-Laban described a structured process to develop a local policy for clinical adaptation for advanced-career physicians:
Literature review and national surveys to understand current practices
Values-based consultations with faculty
Tailored solutions like:
Exclusion from night or resus shifts
Max 7-hour shift pick-ups
Split-shift pools for flexibility
🔑 Wellness isn’t just about yoga mats — it’s about policy that respects lived experience.
2. Simulation for Collective Efficacy
Dr. Eve Purdy – Gold Coast University Hospital, Australia
When her team transitioned into a new ED, Dr. Purdy used simulation not just for clinical prep, but for team resilience.
Sim was used to:
Map out and improve workflows
Explore how team members interact under pressure
Build connection and confidence ahead of major change
Test how the system reacts to common and uncommon scenarios
🔑 Sim isn’t just about skills — it’s about building collective confidence in your team.
3. TMTL: There’s More to Life Than Medicine
Dr. Louise Rang – Queen’s University
In an annual November event, residents and staff come together to share 10-minute talks about anything but medicine.
Hosted at a local restaurant
10–12 talks, with food, drinks, and laughter
Themed versions (e.g., “Family,” or “It seemed like a good idea at the time”) add fun structure
Smaller spin-offs:
“Question of the week” whiteboards
ED photo boards with “Talk to me about…” prompts
🔑 Connection doesn’t require a program — it can start with a story, a smile, or a shared meal.
Wellness in emergency medicine can’t be a side project.
It must be rooted in what your people need, built on mutual respect, and sustained through human connection.
Whether it’s policy, simulation, or storytelling, wellness that works is wellness that belongs to everyone.
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
🔍 Afternoon Concurrent Tracks 2
Drugs and Doses: Toxicology and Addiction: Experts discussed current trends in substance use, overdose management, and the role of emergency departments in addressing addiction.
Dr. Ingrid Berling on QTc in Overdose:
Torsade de Pointes (TdP) is rare — but QT interval assessment in overdose is a daily challenge. Here’s what to keep in mind:
🧠 Clinical Pearls:
• QT prolongation depends on genetics, bradycardia, and electrolytes — not just the drug
• TdP often self-resolves → patient reverts to prolonged QTi
• Never rely on the ECG machine to calculate the QT — often inaccurate
• QT must be assessed in context of HR: slower HR = longer QTi
• Bicarb can prolong QT by inducing hypokalemia
⚠️ Always confirm the QT manually and correct contributing factors — especially potassium.
Disaster Emergency Medicine: This track explores the evolving challenges of mass casualty response, resource-limited care, and health system resilience during large-scale emergencies.
Best Disaster Medicine Publications of 2025, Panel
Disaster medicine continues to evolve — and so does the science behind it. This panel reviewed three standout publications from 2025, each pushing the boundaries of how we think about triage, bystander response, and climate-related surge events.
In-Water Mass Casualty Triage Tool Published in: British Military Health Journal
Disasters at sea or in large bodies of water require a unique approach to triage. This study introduces a novel classification system (W1–W4) based on:
Survivability factors:
Wearing a life jacket
Swimming or floating ability
Inability to stay above water
Dynamic reassessment: Environmental factors like waves, darkness, and cold can alter triage priority over time.
💡 Key Insight: This tool doesn’t replace traditional triage — it enhances aquatic response, with secondary triage required after rescue.
Bystander CPR and Crowd Crush Outcomes Published in: JAMA Emergency Medicine
This paper examined outcomes in mass cardiac arrests due to crowd crush, identifying critical shortcomings in current response:
Predominance of CPR without rescue breaths
Majority of victims were triaged as non-survivable (black)
Questions raised about whether full resuscitation (with breaths) could have saved more lives
💡 Key Insight: Reinforces the need for context-specific triage and highlights gaps in bystander CPR training during crush-related incidents.
Emergency Care Utilization During Floods Published in: JAMA Environmental Health
This study explored how extreme weather events — particularly flooding — impact:
Emergency department visits
Hospitalization rates
Health system surge capacity
💡 Key Insight: As climate change increases flood frequency, understanding these patterns is vital to disaster preparedness planning and resource allocation.
Dr. Farhat Anjum on Disaster Medicine in Formula 1
Formula 1 is not only a sport of speed and precision — it is a live laboratory for disaster medicine, where seconds matter, coordination is critical, and safety innovation saves lives. From fireproof suits to AR-driven medical response, F1 demonstrates how elite preparedness and trust-driven teamwork can shape the future of emergency care.
F1’s early years were marked by frequent fatalities and limited protection. Over time, tragic incidents led to dramatic advances in driver safety:
Halo device: Shields the head from debris impacts up to 12 tonnes
Head and neck restraint systems (HANS): Complements helmet protection during deceleration
Fireproof suits: Resist extreme heat and prolong survivability during vehicle fires
Medical Teams: On Standby at 300 km/h
Behind every lap, there’s a fully mobilized emergency response team — trained, equipped, and in position.
Mobile medical units: Rapid-response vehicles equipped like mini-EDs
AR-enhanced tools: Augmented reality used for situational awareness and extraction planning
Specialized equipment: Designed for quick extrication from tight cockpits
The Team Includes:
Emergency physicians
Paramedics and EMTs
Nurses and trauma support staff
Logistics personnel linked directly to race control
These teams are strategically positioned around the track, ready to respond within seconds, and work in close coordination with local hospitals.
“Trust is the bedrock of teamwork.” - A mantra echoed in both Formula 1 and emergency medicine.
Formula 1 represents disaster medicine at its fastest and most unforgiving. It reminds us that preparation, innovation, and interprofessional trust are not luxuries — they are life-saving necessities.
Whether you’re trackside or in the trauma bay, the same rules apply: train relentlessly, act decisively, and never go alone.
Geriatric Emergency Medicine: Attendees examined best practices for managing the complex needs of older adults in emergency settings.
Dr. Xavier Dubucs on Head Injuries in older Patients,What's New?
Traumatic brain injury (TBI) in older adults is a rising epidemic, with ground-level falls (GLF) as the leading cause. While the prevalence of serious intracranial injury is relatively low, risk stratification remains challenging, especially in patients on antithrombotic medications. New decision rules and emerging biomarkers may help refine who truly needs a CT — and who doesn’t.
40% of TBIs presenting to EDs in Europe are from low-energy falls, with a median patient age of 74.
ED visits for TBI in older adults have increased by 156% over the last decade — but mortality has remained stable.
For bleeding related outcomes meta-analysis of 11 studies (11,102 patients) showed:
5.2% incidence of intracranial hemorrhage
<1% required neurosurgical intervention
DOACs and warfarin are still risk factors, but absolute event rates remain low.
Antiplatelet use is associated with a 1.6x increased risk of intracranial hemorrhage after head trauma.
Traditional rules like CCHR and NEXUS perform poorly in older adults. Reasons include:
Pre-injury cognitive impairment (30%)
Vague or absent symptoms
Anticoagulation complicating risk profiles
New Tools: Dedicated Decision Rules
Several rules aim to better guide imaging decisions:
FALL Decision Rule: Ground-level fall, ≥65 years, validated in multicenter cohorts.
Florida Rule: Head trauma in patients ≥65 with broad inclusion of all injury mechanisms.
CTHEAD Rule (Japan): Includes GCS, vomiting, amnesia — excludes anticoagulated patients.
🧠 These tools need external validation but show promise in guiding safer, more selective imaging.
A study of 3,425 older adults with normal initial CT found:
Delayed ICH in only 0.4%
Only 1 patient needed neurosurgery
Suggests routine repeat CT is likely unnecessary in asymptomatic patients
Take Home Points
Prevalence of serious ICH is low in older adults after ground-level falls.
Anticoagulants and antiplatelets remain relevant but not absolute indicators for CT.
FALL Decision Rule shows promise for selective imaging.
Biomarkers are in development — but not ready yet.
Always assess for head impact and neurological change, regardless of mechanism.
Hard Core EM: Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Dr. Catherine Varner on Hemorrhage in Pregnancy:
Postpartum and early pregnancy hemorrhage are low-frequency, high-stakes presentations. Emergency physicians must be prepared to act rapidly, communicate sensitively, and manage hemorrhage with both clinical precision and compassion. Evidence supports the early use of TXA, structured assessment with the 4 Ts, and careful attention to psychological impacts on patients.
TXA in Postpartum Hemorrhage: Revisiting the Evidence
Dr. Catherine Varner opened with a critical review of tranexamic acid (TXA) in pregnancy-related bleeding.
The WOMAN Trial (over 20,000 participants) demonstrated a reduction in death due to bleeding when TXA was administered.
While the trial’s primary outcome was controversially changed mid-study (from all-cause mortality to bleeding death), the results remain practice-changing.
A 2023 systematic review published in The Lancet (including over 50,000 patients) confirmed that TXA reduces life-threatening hemorrhage.
Bottom line: If a postpartum patient is bleeding, give TXA. The data supports it.
Etiologies of Pregnancy-Related Bleeding: The 4 Ts
Dr. Varner reviewed the classic 4 Ts as causes of hemorrhage
Tone – uterine atony
Tissue – retained placenta or products of conception
Trauma – lacerations, uterine rupture
Thrombin – coagulopathies
The timing of pregnancy guides the most likely etiology and management approach:
First trimester & postpartum = most common ED presentations
Late third trimester hemorrhage = rare and high-risk (often seen outside of OB units)
7–10 days postpartum = consider retained tissue or endometritis
Dr. Varner emphasized the need to prepare the room like a trauma bay:
Mobilize obstetrics and the blood bank early
Ensure access to postpartum hemorrhage medications (ideally preloaded in a kit)
The “New 4 Ts” for Management:
Tone – uterotonics + fundal massage
TXA – 1g IV over 10 min (repeat in 30 min if needed)
Transfusion – activate massive transfusion protocol if necessary
Temperature – maintain normothermia to support coagulation
Uterotonics: Know the Doses & Contraindications
Managing uterine atony starts with fundal massage and administration of uterotonics:
Medication | Dose | Route |
Oxytocin | 40 units | IV infusion |
Ergonovine | 0.25 mg | IM |
Carboprost | 250 mcg x1 | IM |
Misoprostol | 800 mcg | SL or PR |
Pro tip: Prepare a uterotonic kit with pre-dosed meds + contraindication sheet — a valuable QI initiative.
Resources like the Safe Motherhood Initiative provide printable management posters that can be stocked in high-acuity areas.
Hemorrhage in the Second and Third Trimesters
Between 20–40 weeks, causes differ:
Presentation | Likely Cause |
Painless bleeding | Placenta previa, vasa previa |
Painful bleeding | Abruption, uterine |
Key priorities:
Hemodynamic stabilization
Rapid OB involvement
Postpartum Hemorrhage (Day 7–10): Think Tissue and Sepsis
Retained tissue is the most common cause.
Perform a pelvic exam – tissue in the cervical os may be easily removable, often restoring vagal tone.
Don’t forget endometritis – if the patient is febrile or appears systemically unwell, give broad-spectrum antibiotics.
First Trimester Loss: Advocate, Intervene, Communicate
When managing hemorrhage in early pregnancy:
Retained tissue in the cervical os is a common and treatable cause.
Perform a speculum exam — removing the tissue often rapidly improves bleeding and symptoms.
If bleeding cannot be controlled, advocate for surgical management — emergency physicians sometimes need to push for OR access.
For patient resources from an ED perspective, visit: 🌐 pregnancyed.com
Dr. Adrianna Rowe on Toxicologic Shock, What to Do When Nothing is Working:
Toxin-induced shock can be complex, especially when the ingested substance is unknown. In toxicologic emergencies with hypotension and shock, move quickly through fluids, reach for vasopressors early, and maintain a broad differential — including sodium channel blockade, mitochondrial poisons, and rare causes like methemoglobinemia.
Most toxicology cases are straightforward — when you know the agent.
But when a patient arrives with shock of unknown origin, management becomes significantly more challenging.
Case: The “Suicide Kit”
A 20-year-old woman is brought in by EMS after reportedly ingesting a “suicide kit.”
She was found with empty medication packs and alcohol bottles.
On arrival:
GCS: 3
BP: 70/30
No known substance identified
Step 1: Start with the ECG
Look for signs of sodium channel blockade:
QRS widening
Terminal R wave in aVR
Brugada-like patterns
If present, consider:
Sodium bicarbonate
Lidocaine (for resistant arrhythmias)
⚠️ Remember: not all wide QRS = sodium channel toxicity.
Pre-existing conditions or agents like bupropion may alter the ECG differently.
Step 2: Is the Heart Irritable?
If the ECG looks bizarre, or the rhythm seems chaotic or unstable, think about:
Cardiac glycosides (e.g., digoxin, plant alkaloids, amphibian toxins)
These toxins can make the myocardium electrically unstable, resulting in difficult-to-interpret rhythms and refractory shock.
Step 3: Resuscitate Like It’s Tox
Fluids?
Often unhelpful — most patients are not volume-depleted.
Use small boluses if needed, but move early to vasopressors.
Vasopressors?
Norepinephrine is your first-line agent.
Works for distributive, cardiogenic, and vasoplegic shock.
Central Access?
These patients often need very high-dose vasopressors — get central access early.
Step 4: Use POCUS to Guide
If you see poor contractility on bedside echo:
Add a beta-agonist inotrope (e.g., epinephrine or dobutamine)
Or start high-dose insulin euglycemic therapy (HIET) for calcium channel or beta-blocker overdose.
Step 5: Think Mitochondrial Toxins
If shock is refractory to vasopressors, think about mitochondrial poisons, commonly included in “suicide kits”:
Key Mitochondrial Toxins:
Cyanide
Clues: high lactate, high PO₂ on venous gas, Normal O₂ saturation despite hypoxia, responds to hydroxycobalamin
Carbon monoxide
Sodium nitrite
Methemoglobinemia
Clues: Pulse oximetry fixed at 85%, Chocolate-brown blood Responds to methylene blue
Step 6: Refractory Vasoplegia? More Squeeze, Please
If you’ve ruled out cyanide/methemoglobinemia and shock continues, try:
Methylene blue (first-line)
Hydroxycobalamin (can be adjunctive, especially if methylene blue is unavailable)
G6PD deficiency — risk of hemolysis
💡 Hydroxycobalamin may reduce vasopressor requirements more than methylene blue, but it’s expensive and interferes with lab assays.
Step 7: Lipid Emulsion Therapy
Indicated for:
Local anesthetic systemic toxicity (LAST)
Suspected overdose of lipophilic agents
Refractory arrhythmia or shock
Use lipid emulsion late in your algorithm unless clear iatrogenic source (e.g., bupivacaine overdose).
Step 8: Consider ECMO
ECMO is an option in:
Refractory cardiogenic shock (e.g., calcium channel or beta-blocker OD)
Unstable arrhythmias unresponsive to conventional therapy
Think: bupropion, sodium channel blockers
Involve ECMO team early when available.
In highly unstable patients, time matters.
Key Takeaways:
Toxicologic shock requires fast thinking, pattern recognition, and comfort with unconventional therapies. When standard treatments aren’t working, think outside the box — and don’t wait too long to escalate.
Start with ECG — look for sodium channel or irritable myocardium patterns
Move quickly from fluids to norepinephrine
Use POCUS to tailor therapy
Think about mitochondrial toxins if refractory
Reach for methylene blue, hydroxycobalamin, and lipid emulsion when needed
Don’t forget ECMO in select cases
Dr. Anton Helmon on Eating Disorders in the ED (Click to read more)
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
🏁 PoCUS Competition Final: Skill, Speed and Creatitivity Collide
The PoCUS Competition Final saw “Echo Location” (McGill University) face off against “Jelics Angels” (University of Manitoba) in a thrilling conclusion to this annual event.
In the final challenge, teams had to locate a hidden key within an ultrasound model and skillfully extract it using only rounded forceps — a test of both image interpretation and fine motor control.
Next came the macromodel round, where competitors used props to physically recreate ultrasound concepts, prompting judges to guess the topic based on visual clues — like ureteric jets cleverly represented on stage.
In the end, Echo Location from McGill came out victorious!
Thank you to all the participants — the team names, creativity, and costumes continue to impress us year after year!
🎭 Evening Improv Session
The day concluded with an engaging improv session, offering attendees a chance to unwind and connect through humor and creativity. The session emphasized the value of adaptability and communication—key skills in emergency medicine.
Stay tuned for tomorrow’s recap as we continue to explore the innovations and collaborations shaping the future of emergency medicine at ICEM 2025, presented to you by the #ICEM2025 Social Media team!
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