#1: Can We Discharge BIG-1 Traumatic Head Bleeds?
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This systematic review and meta-analysis argues that the Brain Injury Guidelines (BIG) can be used to discharge appropriate patients from the ED.
Source
Brain injury guidelines for the management of traumatic brain injury: a systematic review and meta-analysis. CJEM. 2026 Oct;28(10):968-981. doi: 10.1007/s43678-026-01218-y. Epub 2026 Oct 2. PMID: 42827223.
#2: Is This SODa Flat? Bicarb for ICU Patients
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In vasopressor-dependent patients with metabolic acidosis, sodium bicarbonate administration corrected acidemia but did not reduce mortality, need for renal-replacement therapy, or renal dysfunction by 30 days.
Source
Sodium Bicarbonate for Critically Ill Adults with Metabolic Acidosis and Shock. N Engl J Med. 2026 Sep 17;395(11):1062-1074. doi: 10.1056/NEJMoa2600526. Epub 2026 Jun 12. PMID: 42283370.
#3: Dual Simultaneous A-fib Cardioversion?
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Simultaneous dual-defibrillator cardioversion converted nearly four of five patients with atrial fibrillation (AF) who failed single-device cardioversion, though the evidence was largely observational, in older studies, not done in the ED, and used monophasic technology.
Source
Dual direct current external cardioversion in refractory atrial fibrillation: a systematic review and single-arm meta-analysis. Am J Emerg Med. 2026 Sep 16:S0735-6757(26)00490-0. doi: 10.1016/j.ajem.2026.09.026. Epub ahead of print. PMID: 42784943.