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.
In selected late-window ischaemic stroke, HOPE finds more patients with little or no disability after alteplase, alongside more symptomatic intracranial haemorrhage. Limited evidence for known-onset stroke beyond nine hours and the definition of functional recovery complicate interpretation.
Paediatric faltering weight requires accurate measurements, assessment of growth trajectory and a detailed feeding history. Low Z-scores are screening triggers rather than diagnoses, while investigation and admission decisions should reflect clinical risk, specific symptoms and the feasibility of safe outpatient follow-up.
Clinically indicated vasopressors can start through an appropriate, closely monitored short peripheral IV rather than waiting for central access. Serious complications appear uncommon, but heterogeneous, predominantly observational evidence does not establish equal or superior safety to central administration.
In a 93-patient superiority trial, intramuscular ketorolac 10 mg did not provide better one-hour pain relief than oral ibuprofen 400 mg for selected adults with acute atraumatic musculoskeletal back pain. The result does not establish equivalence or non-inferiority.
Adding intravenous paracetamol to titrated morphine for severe acute pain may provide additional analgesia, but non-inferiority results, secondary outcomes, selected participants and the absence of an oral comparator leave the size and clinical importance of any benefit uncertain.
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.
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