Clinical Insights
Evidence-based clinical guidance, simulation strategies, and educational insights for emergency medicine physicians, residents, and advanced practice providers.
Clinical insights for emergency physicians and residents: RSI decision-making, POCUS, ACLS updates, sepsis bundles, and the hypotensive patient.
Chester "Chet" Shermer, MD, FACEP · October 22, 2026
The Glasgow-Blatchford score sends very low-risk patients home, a 7 g/dL threshold beat liberal transfusion, and HALT-IT removed tranexamic acid. What the evidence asks of the ED.
Read Upper GI Bleeding in the ED: Score, Transfuse Low, Skip the TXA
Chester "Chet" Shermer, MD, FACEP · October 22, 2026
Aortic dissection hides inside the chest pain pathway. How the ADD-RS and D-dimer rule-out performs, which scan to order, and the 2022 ACC/AHA initial targets: heart rate 60 to 80, systolic below 120, beta blocker first.
Read Aortic Dissection in the ED: Rule It Out, Then Slow It Down
Chester "Chet" Shermer, MD, FACEP · October 15, 2026
The 2025 ATS guideline now suggests corticosteroids for severe community-acquired pneumonia. Here are the criteria, the trials behind them, and why the 24-hour window starts in the ED.
Chester "Chet" Shermer, MD, FACEP · October 15, 2026
The 2024 hyperglycemic crises consensus allows subcutaneous rapid-acting insulin for uncomplicated mild or moderate DKA. Who qualifies, what the evidence shows, and how to run the checks.
Chester "Chet" Shermer, MD, FACEP · October 8, 2026
An NIHSS of 2 can still be a disabling stroke. How the 2026 AHA/ASA guideline, PRISMS, ARAMIS, and TEMPO-2 shape the lytic decision for low-score patients.
Read Low NIHSS Stroke: Thrombolysis Turns on Disabling Deficits
Chester "Chet" Shermer, MD, FACEP · October 8, 2026
Andexanet is gone from the US market. What ANNEXA-I and the 2026 NCS/SCCM guideline update mean for reversing apixaban and rivaroxaban in intracranial hemorrhage.
Read Factor Xa Inhibitor Brain Bleeds: Reversal After Andexanet
Chester "Chet" Shermer, MD, FACEP · October 8, 2026
The ED cases that decide survival are the ones you see once every few years. Five to rehearse, from CICO to lateral canthotomy, and how to build each scenario.
Read High-Risk, Low-Frequency ED Simulation Cases Worth Running
Chester "Chet" Shermer, MD, FACEP · September 24, 2026
A positive CT is not the end of the pulmonary embolism decision. Start with pretest probability, separate diagnosis from severity, and let physiology drive treatment and disposition.
Chester "Chet" Shermer, MD, FACEP · September 17, 2026
After ROSC, temperature management is a deliberate plan, not an automatic 33°C reflex. A practical ED guide to fever prevention, handoff, and current evidence.
Read After ROSC in the ED: Temperature Control Without the Old TTM Script
Chester "Chet" Shermer, MD, FACEP · September 10, 2026
A practical ED approach to refractory anaphylaxis: repeat IM epinephrine, resuscitate shock, and move to a monitored infusion before the patient crashes.
Chester "Chet" Shermer, MD, FACEP · September 3, 2026
A practical ED sequence for adult convulsive status epilepticus: treat at five minutes, dose the benzodiazepine fully, choose a second-line agent, and keep airway and EEG decisions active.
Read Convulsive Status Epilepticus in the ED: Dose, Then Decide
Chester "Chet" Shermer, MD, FACEP · August 27, 2026
A practical ED sequence for hyperkalemia: verify the result, read the ECG, protect the heart, shift potassium, prevent insulin-related hypoglycemia, and plan definitive removal.
Read Hyperkalemia in the ED: Protect the Heart, Shift the Potassium, Plan the Exit
Chester "Chet" Shermer, MD, FACEP · August 27, 2026
A sedated arrival is not automatically an intubation. What the evidence says about prehospital ketamine, and the two questions to ask before the crew leaves.
Chester "Chet" Shermer, MD, FACEP · August 20, 2026
A practical first-hour framework for adult acute asthma in the ED: treat early, reassess visibly, recognize failure, and make discharge part of treatment.
Chester "Chet" Shermer, MD, FACEP · August 13, 2026
We credential central lines and rehearse intubations, then improvise the transfer of twelve patients at shift change. The evidence says sign-out is a procedure, and it deserves procedural discipline.
Read The Handoff Is a Procedure: Why Sign-Out Deserves the Same Discipline as a Central Line
Chester "Chet" Shermer, MD, FACEP · May 19, 2026
Why sepsis bundle compliance gaps persist and how emergency physicians can close them. Hour-1 bundle breakdown, common barriers, and the cognitive framework that saves lives.
Read Sepsis Bundle Compliance: Closing the Gap Between Guidelines and Bedside Practice
Chester "Chet" Shermer, MD, FACEP · May 19, 2026
Critical pediatric resuscitation pearls for emergency providers. Weight-based dosing, airway differences, vascular access strategies, and the cognitive errors that cost lives.
Read Pediatric Resuscitation Pearls: What Every Emergency Provider Must Know
Chester "Chet" Shermer, MD, FACEP · May 19, 2026
Master the FAST exam with this step-by-step guide for emergency physicians. Learn the four views, common pitfalls, and how POCUS changes resuscitation decisions in trauma.
Read FAST Exam Mastery: A Practical Guide for Emergency Physicians
Chester "Chet" Shermer, MD, FACEP · May 18, 2026
Updated for the 2025 AHA adult CPR/ECC guidelines: prompt defibrillation without a fixed two-minute delay, uncertain benefit from double sequential defibrillation, IV-first access, and current post-arrest temperature care.
Read ACLS Updates: Critical Changes Every Emergency Provider Must Know
Chester "Chet" Shermer, MD, FACEP · May 18, 2026
When a hypotensive patient rolls through your ED doors, your first 10 minutes determine outcomes. Here's a systematic framework for the undifferentiated hypotensive patient.
Read Managing the Undifferentiated Hypotensive Patient: A Systematic Approach
Chester "Chet" Shermer, MD, FACEP · May 18, 2026
High-fidelity simulation is reshaping how emergency physicians learn and maintain clinical competency. Here's the evidence — and what it means for your training.
Read Why Simulation Training Is Transforming Emergency Medicine Education
Chester "Chet" Shermer, MD, FACEP · May 18, 2026
Point-of-care ultrasound has transformed emergency medicine. Learn the essential ultrasound-guided procedures every EM resident must master before graduation.
Read Ultrasound-Guided Procedures in the ED: What Every Resident Needs to Know
Chester "Chet" Shermer, MD, FACEP · May 18, 2026
Master the RSI decision framework with a systematic approach to airway management in the emergency department. From pre-oxygenation to post-intubation care.
Read Rapid Sequence Intubation: A Step-by-Step Decision Framework for Emergency Physicians