August 17, 2026 – August 23, 2026
Weekly Roundup
16 resources from 9 sources were added to the FOAM Cortex library this week and are now indexed. Explore a selection below, with links to the original educators.
10 highlights · 7 featured sources
EM@3AM: Thoracic Outlet Syndrome
This emDOCs EM@3AM review covers thoracic outlet syndrome (TOS), emphasizing that neurogenic TOS (90–95% of cases) presents with positional upper-extremity pain, paresthesias, and heaviness worsened by arm elevation, and is a clinical diagnosis of exclusion. Venous and arterial subtypes require urgent ED anticoagulation and vascular surgery consultation, while neurogenic TOS can be discharged with physical therapy referral.
“Robo-Tripping”: Dextromethorphan Overdose
This emergency medicine review covers dextromethorphan (DXM) overdose, highlighting its mixed dissociative/serotonergic/sympathomimetic toxidrome and the underrecognized DANCE syndrome—cytotoxic cerebellar edema in children under 6—where early aggressive supportive care and prompt MRI are critical; emerging case-series data suggest IV methylprednisolone may improve outcomes when DANCE is recognized early, though evidence remains limited.
Ideal Rocuronium Dosing – How to Avoid ‘Mostly Paralyzed’
In this retrospective analysis of ED and ICU patients, rocuronium doses above 1.2 mg/kg were associated with improved first-pass intubation success compared with standard dosing, but higher doses did not affect downstream clinical outcomes. Retrospective design limits causal conclusions.
OMI-nously Yours: Is it time to re-think Code STEMI?
This review article argues that traditional STEMI criteria have a pooled sensitivity of only ~44% for angiographically confirmed acute coronary occlusion, and that in one prospective study 38% of occlusion MIs (OMIs) did not meet STEMI criteria—with median time to catheterization 437 vs. 41 minutes for those who did. The authors propose the OMI/NOMI framework as a complement to current pathways, while noting it lacks prospective outcome validation and consistent positive predictive value data.
#83 B2B Pulse Oximetry
This episode reviews pulse oximetry across skill levels, highlighting that SpO₂ targets of 92–96% (88–92% in COPD) are evidence-based, while hyperoxia carries signals of harm in ARDS, MI, and stroke. Key limitations covered include a 15–30 second lag, perfusion dependence, inability to detect abnormal hemoglobins, and systematic overestimation of SpO₂ in darker-skinned patients due to racially homogeneous original calibration studies.
The Case of the Neutral Documents Part 2
This EM Nerd piece traces the rise and fall of sodium bicarbonate in ICU metabolic acidosis: the original BICAR-ICU-1 subgroup signal (17-point mortality reduction in AKI patients) was not replicated in BICAR-ICU-2 (0.4% mortality difference, p=0.91), and SODa-BIC found no difference in MAKE30, RRT, or mortality versus placebo—suggesting the initial finding was likely a chance result amplified by underpowering and multiple comparisons.
Trick of the Trade: Improvised Collar and Cuff Sling Using Soft Limb Holders
This "Trick of the Trade" describes constructing an improvised collar-and-cuff sling from two Posey soft limb holders when a standard sling is unavailable. The technique supports the wrist while allowing the elbow to hang freely, applying gravity traction to maintain alignment in proximal humerus fractures; padding from the second holder cushions the neck to prevent strap irritation during 1–3 weeks of wear.
ECG Pointers: The Journey of aVR
This article traces the evolving interpretation of ST elevation in lead aVR, concluding it should not be considered diagnostic of left main coronary artery (LMCA) occlusion or a STEMI equivalent—a position reflected in both the 2013 and 2025 ACC/AHA guidelines. A 2020 meta-analysis of 14 studies found sensitivity of only 40% for high-grade coronary disease; however, aVR elevation during ACS was associated with higher in-hospital mortality, reinfarction, and heart failure across over 7,700 patients.
One and Done? Dexamethasone for Pediatric Asthma
This retrospective cohort study in Annals of Emergency Medicine found no difference in ED revisits or hospitalizations between children receiving a single dose versus two doses of dexamethasone for asthma exacerbations, suggesting one dose may be sufficient—though the retrospective design limits causal conclusions.
emDOCs Podcast – Episode 146: Pediatric Gastric and Midgut Volvulus
This emDOCs episode reviews pediatric gastric and midgut volvulus, emphasizing that bilious emesis in an infant should be treated as midgut volvulus until proven otherwise. Upper GI series remains the diagnostic gold standard, though ultrasound sensitivity reaches 83–100%; ACR cautions against using a negative ultrasound to exclude midgut volvulus. All cases require emergent pediatric surgical consultation.
New to the library does not necessarily mean newly published. This roundup features public resources added during the week and successfully indexed by the time the issue was prepared. Follow the links to read or listen at the original source.