The Skeptics' Guide to Emergency Medicine (SGEM) is an educational podcast dedicated to promoting evidence-based practices in emergency medicine. Hosted by Dr. Ken Milne, the podcast critically appraises recent research and clinical guidelines, aiming to bridge the gap between current evidence and clinical practice.
Critical appraisal should examine methods, bias, effect size, precision, applicability and patient-oriented outcomes rather than publication prestige or statistical significance alone, while integrating evidence with clinical expertise, patient values and respectful scepticism.
The paediatric pulmonary embolism rule-out tool PERC-PEDS may support ending testing in carefully selected children aged 4–17 years once clinical pre-test probability is below 15% and every criterion is negative. A positive result or negative D-dimer alone cannot settle the diagnosis.
A randomised preprint in critically ill patients with confirmed influenza finds no 90-day survival benefit from five or ten days of oseltamivir and raises a possible harm signal. Site selection, baseline imbalance and treatment crossover limit certainty about its size.
Evidence-based medicine integrates research, clinical expertise and patient values rather than demanding obedience to trials or guidelines. Diagnostic uncertainty, bias, incomplete reporting, randomisation and careful use of artificial intelligence shape the practical appraisal of clinical decisions.
An injured child with a displaced medial epicondyle fracture needs analgesia, immobilisation, careful ulnar nerve assessment and repeat imaging after any elbow reduction. Definite operative indications differ from displacement alone, and the SCIENCE trial supports non-surgical care as the default for isolated injuries within its studied population.
Emergency clinicians and educators get a reflective, systems-focused discussion of teamwork, diagnostic uncertainty, technology and clinician wellbeing. Clear roles, shared mental models, patient advocacy and deliberate revision of the working diagnosis are presented alongside practical recognition of burnout, moral injury and post-traumatic stress.
Paediatric emergency and respiratory clinicians get an antibiotic-stewardship update for moderate to severe preschool wheeze. The episode links PRAM scoring, oxygenation, work of breathing, bronchodilator response and systemic corticosteroids with evidence that azithromycin does not improve symptom severity, length of stay or early return visits without a separate bacterial indication.
Emergency and critical-care teams get a focused appraisal of restricted fluids and early norepinephrine in adult septic shock. The ARISE Fluids findings are placed alongside fluid responsiveness, pulmonary oedema risk, peripheral vasopressor use and repeated bedside reassessment rather than automatic volume targets.
Paediatric emergency clinicians get a foreign-body ingestion risk-stratification episode. Small smooth blunt plastic objects in a well child usually pass spontaneously, while button batteries, multiple magnets, sharp objects, symptoms, uncertain high-risk history and deterioration require urgent escalation.
Acute-care and surgical teams get a practical framing for CT-confirmed uncomplicated appendicitis. It keeps antibiotics with observation tied to careful selection, appendicolith risk, surgical involvement, patient trade-offs, local antimicrobial guidance and written safety-netting for deterioration or recurrence.
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