must read em journal articlesIn November 2013, the blog post 52 Articles in 52 weeks: Landmark EM Articles for EM interns was published on the ALiEM site. Over the subsequent years, many ground-breaking and practice-changing articles have been published. As part of a multi-institutional initiative launched by the ALiEM Chief Resident Incubator (“The Crincubator”), 9 chief residents from across the country pooled together lists of journal articles thought to be most important for the broad spectrum of EM learners. Additional input was obtained from FOAM leaders across the country including Dr. Ryan Radecki and Dr. Jeffrey Kline. These lists can be used by individuals for further learning or by residency programs for journal clubs.

Journal Article Selection

These selected journal articles were not restricted to those solely published in the last 2 years, but included groundbreaking articles regardless of their publication date. Lists were then created based on their relevance for junior residents and senior residents/attending physicians. Another list was created which includes controversial hot topics. Each list contains 12 sections to provide a monthly reading list for the individual EM practitioner or longitudinal curriculum for residency programs (e.g. monthly journal clubs). Although these lists are by no means comprehensive, they do cover a large breadth of topics relevant to all EM practitioners.

Special mention contributors: Dr. Casey Hand and Dr. Joe Kennedy

Junior Residents

This compilation of articles was put together to help medical students and junior residents to learn the reasons behind why we practice the way we do in emergency medicine.

Article Clinical Question
1Six AJ, Backus BE, Kelder JC. Chest pain in the emergency room: value of the HEART score. Neth Heart J. 2008; 16(6): 191-6. PMID: 18665203Can the HEART score reliably predict outcomes in chest pain patients?
2CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010; 376(9734): 23-32. PMID: 20554319Should tranexamic acid be considered in the management of trauma patients with significant hemorrhage?
3Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009; 374(9696): 1160-70. PMID: 19758692When is a head CT indicated in children with blunt head trauma? [PV card]
4Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000; 343(2): 94-9. PMID: 10891516What criteria can be used to rule out cervical spine injury without imaging? How were these criteria defined in the study?
5Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003; 349(26): 2510-8. PMID: 14695411How does the Canadian C-Spine rule compare with the NEXUS criteria for ruling out cervical spine injury?
6Stiell IG, Clement CM, Rowe BH, et al. Comparison of the Canadian CT Head Rule and the New Orleans Criteria in patients with minor head injury. JAMA. 2005; 294(12): 1511-8. PMID: 16189364What are the criteria for clinically ruling out head injury in patients with blunt head trauma? How does the Canadian CT Head Rule compare with the New Orleans Criteria?

Stiell IG, Greenberg GH, McKnight RD, et al. Decision rules for the use of radiography in acute ankle injuries. Refinement and prospective validation. JAMA. 1993; 269(9): 1127-32. PMID: 8433468

Stiell IG, Greenberg GH, Wells GA, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA. 1996; 275(8): 611-5. PMID: 8594242

What criteria can be used to rule out significant foot, ankle, and knee injuries without imaging? [PV card]
8Sharifi M, Bay C, Skrocki L, Rahimi F, Mehdipour M, “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol. 2013; 111(2): 273-7. PMID: 23102885Should “safe dose” tPA be given to patients with submassive pulmonary embolism? Is it safe? How efficacious is it?

ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014; 370(18): 1683-93. PMID: 24635773

ARISE Investigators, ANZICS Clinical Trials Group, Peake SL, et al. Goal-directed resuscitation for patients with early septic shock. N Engl J Med. 2014; 371(16): 1496-506. PMID: 25272316

Mouncey PR, Osborn TM, Power GS, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015; 372(14): 1301-11. PMID: 25776532

In the current management of sepsis, does early goal-directed therapy improve outcomes compared with usual care?
10Holst LB, Haase N, Wetterslev J, et al. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med. 2014; 371(15): 1381-91. PMID: 25270275What hemoglobin threshold should be used for transfusing septic patients?
11Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012; 59(3): 165-75.e1. PMID: 22050948What techniques can be utilized to improve preoxygenation and prevent desaturation in the peri-intubation setting?
12Pickard R, Starr K, MacLennan G, et al. Medical expulsive therapy in adults with ureteric colic: a multicentre, randomised, placebo-controlled trial. Lancet. 2015; 386(9991): 341-9. PMID: 25998582Are tamsulosin or nifedipine more effective than placebo for improving ureteral stone passage?


Senior Residents and Attendings

This list was designed with slightly more advanced topics that are best suited for those further along in their training.

Article Clinical Question
1Wyse DG, Waldo AL, DiMarco JP, et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002; 347(23): 1825-33. PMID: 12466506Which will help a patient with atrial fibrillation more? Rate or rhythm control?
2Anderson CS, Heeley E, Huang Y, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013; 368(25): 2355-65. PMID: 23713578Does standard, or rapid, lowering of blood pressure in acute intracranial hemorrhage improve outcomes?
3Delaney KA, Vassallo SU, Larkin GL, Goldfrank LR. Rewarming rates in urban patients with hypothermia: prediction of underlying infection. Acad Emerg Med. 2006; 13(9): 913-21. PMID: 16946289What is the underlying cause of a patient’s hypothermia? Could s/he be septic?
4Newman-Toker DE, Kerber KA, Hsieh YH, et al. HINTS outperforms ABCD2 to screen for stroke in acute continuous vertigo and dizziness. Acad Emerg Med. 2013; 20(10): 986-96. PMID: 24127701Should I use the ABCD2 score or the HINTS exam to determine the likelihood of stroke in a dizzy patient?
5Leuppi JD, Schuetz P, Bingisser R, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA. 2013; 309(21): 2223-31. PMID: 23695200Should I send my COPD patient home on a 14 day or 4 day course of oral steroids?
6Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372(11): 1019-30. PMID: 25671798Do I need to call the neurointerventionalist to retrieve this clot in my patient with an ischemic stroke?
7Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015; 372(1): 11-20. PMID: 25517348Does intraarterial treatment of ischemic stroke improve outcomes?
8Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013; 368(1): 11-21. PMID: 23281973Should I transfuse my patient with a hemoglobin of 7 g/dL (restrictive strategy) or 9 g/dL (liberal strategy) in the setting of a gastrointestinal bleed? 
9Easter JS, Haukoos JS, Claud J, et al. Traumatic intracranial injury in intoxicated patients with minor head trauma. Acad Emerg Med. 2013; 20(8): 753-60. PMID: 24033617Do my traditional head injury decision rules apply to the intoxicated patient population?
10Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015; 313(23): 2340-8. PMID: 26080338Should your patient with appendicitis just receive a trial of antibiotics instead of surgery as a first line approach?
11Mal S, McLeod S, Iansavichene A, Dukelow A, Lewell M. Effect of out-of-hospital noninvasive positive-pressure support ventilation in adult patients with severe respiratory distress: a systematic review and meta-analysis. Ann Emerg Med. 2014; 63(5): 600-607.e1. PMID: 24342819Does use of NIPPV (noninvasive positive pressure ventilation) in the pre-hospital setting improve outcomes in acute respiratory distress patients?
12Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012; 366(7): 591-600. PMID: 22335736Does route of benzodiazepine administration change time to seizure control in pre-hospital status epilepticus?


Controversial Topics

The collection was put together with controversial, novel, or potentially practice changing topics to help us think about new things on the horizon and stimulate discussion amongst colleagues.  

Article Clinical Question
1Inaba K, Lustenberger T, Recinos G, et al. Does size matter? A prospective analysis of 28-32 versus 36-40 French chest tube size in trauma. J Trauma Acute Care Surg. 2012; 72(2): 422-7. PMID: 22327984Does chest tube size in traumatic injury change outcomes and patient satisfaction?
2Isacson D, Thorisson A, Andreasson K, Nikberg M, Smedh K, Chabok A. Outpatient, non-antibiotic management in acute uncomplicated diverticulitis: a prospective study. Int J Colorectal Dis. 2015; 30(9): 1229-34. PMID: 25989930Should this uncomplicated acute diverticulitis patient be given oral antibiotics?
3Marik PE, Flemmer M, Harrison W. The risk of catheter-related bloodstream infection with femoral venous catheters as compared to subclavian and internal jugular venous catheters: a systematic review of the literature and meta-analysis. Crit Care Med. 2012; 40(8): 2479-85. PMID: 22809915Is my patient at higher risk of infection if I place a femoral central venous catheter over an internal jugular or subclavian catheter?
4Nielsen N, Wetterslev J, Cronberg T, et al. Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23): 2197-206. PMID: 24237006My post-cardiac arrest patient needs to be cooled, do I cool to 33°C, or is 36°C sufficient?  Will this change my patient’s outcome?
5Stub D, Smith K, Bernard S, et al. Air Versus Oxygen in ST-Segment-Elevation Myocardial Infarction. Circulation. 2015; 131(24): 2143-50. PMID: 26002889In medical school I learned about MONA therapy for all of my STEMI patients.  Do they still need oxygen even if they are not hypoxic? Does this improve my patient’s chance of a good outcome?
6McCormack RF, Hutson A. Can computed tomography angiography of the brain replace lumbar puncture in the evaluation of acute-onset headache after a negative noncontrast cranial computed tomography scan? Acad Emerg Med. 2010; 17(4): 444-51. PMID: 20370785I am concerned my patient has a subarachnoid hemorrhage as the cause of his headache, do I need to perform a lumbar puncture to prove/disprove this?
7Semler MW, Janz DR, Lentz RJ, et al. Randomized Trial of Apneic Oxygenation during Endotracheal Intubation of the Critically Ill. Am J Respir Crit Care Med. 2016; 193(3): 273-80. PMID: 26426458Will apneic oxygenation during intubation prevent my patient from desaturating early in the procedure?
8Grunau BE, Wiens MO, Rowe BH, et al. Emergency Department Corticosteroid Use for Allergy or Anaphylaxis Is Not Associated With Decreased Relapses. Ann Emerg Med. 2015; 66(4): 381-9. PMID: 25820033Will the addition of corticosteroids in my anaphylactic patient help to prevent future allergy relapses?
9Righini M, Van Es J, Den Exter PL, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014; 311(11): 1117-24. PMID: 24643601Can I adjust my D-dimer for my patient’s age to aid in ruling-out pulmonary embolism? What about in pregnancy?

Moore CL, Bomann S, Daniels B, et al. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone–the STONE score: retrospective and prospective observational cohort studies. BMJ. 2014; 348: g2191. PMID: 24671981

Smith-Bindman R, Aubin C, Bailitz J, et al. Ultrasonography versus computed tomography for suspected nephrolithiasis. N Engl J Med. 2014; 371(12): 1100-10. PMID: 25229916

Can I avoid unnecessarily irradiating my renal colic patient and diagnose nephrolithiasis with ultrasound? Is there a decision rule I can use to help determine the likelihood that my patient has a kidney stone?
11Beam DM, Kahler ZP, Kline JA. Immediate Discharge and Home Treatment With Rivaroxaban of Low-risk Venous Thromboembolism Diagnosed in Two U.S. Emergency Departments: A One-year Preplanned Analysis. Acad Emerg Med. 2015; 22(7): 788-95. PMID: 26113241Can I send my newly diagnosed venous thromboembolism patient home with oral anticoagulation and outpatient follow up?
12Schwarz ES, Cohn BG. Is dexamethasone as effective as prednisone or prednisolone in the management of pediatric asthma exacerbations? Ann Emerg Med. 2015; 65(1): 81-2. PMID: 24954577Getting kids to take medication can be so difficult sometimes. Could a single home dose of dexamethasone be sufficient to treat a pediatric asthma exacerbation?

Allison Trop, MD

Allison Trop, MD

Champion, Chief Resident Incubator (2016-2018)
Clinical Assistant Professor University of Colorado School of Medicine
Allison Trop, MD

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Fareen Zaver, MD

Fareen Zaver, MD

Chief Operating Officer, Chief Resident Incubator 2017-18
Lead Editor/Co-Founder of ALiEM Approved Instructional Resources - Professional (AIR-Pro)
Champion, 2016-17 ALiEM Chief Resident Incubator
Board Member, 2016-17 ALiEM Wellness Think Tank
Deputy Head - Education and Clinical Assistant Professor for Emergency Medicine
University of Calgary Emergency Department
Fareen Zaver, MD


@UCalgaryEM Clinical Educator, interests in transition to practice, gender equity, #FOAMed @ALiEMteam & @WeAreCanadiEM #Meded #genderequity
Michael Gottlieb, MD, RDMS

Michael Gottlieb, MD, RDMS

Emergency Ultrasound Director
Rush University Medical Center
Chief Academic Officer
ALiEM Faculty Incubator
Melody Glenn, MD

Melody Glenn, MD

Emergency Physician
Highland Hospital
Sutter Delta Medical Center
Workit Health