The Hallway Consult

The EM literature, translated for your next shift.

Nov 9, 2026

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5 min read

The Hallway Consult — Issue #29: Pediatric PERC, the Modified Valsalva, and the 1-Hour Troponin Pathway

This week covers three things you can change on your next shift without a new drug or a new device. Can a bedside rule keep a teenager with chest pain out of the CT scanner? Should every stable SVT get the leg raise? Will switching your troponin pathway to 1 hour actually empty your waiting room? The short answers: sometimes, yes, and not by itself.

Matthew Barmmer

The Hallway Consult — Issue #28: Thrombolysis for Retinal Artery Occlusion, CT Coronary Angiography After a Negative Workup, and IV Magnesium for Headache

Nov 2, 2026

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5 min read

The Hallway Consult — Issue #28: Thrombolysis for Retinal Artery Occlusion, CT Coronary Angiography After a Negative Workup, and IV Magnesium for Headache

This week covers three questions that come up at 3 a.m. with someone leaning on you for an answer. Should the "eye stroke" in your lytic window get a lytic? Should the chest pain patient you just ruled out get a CT coronary angiogram on the way out? Is the magnesium bag on your headache order set doing anything? The short answers: not on current evidence, no, and only a little.

Matthew Barmmer

The Hallway Consult — Issue #27: Ambulatory ECG for Unexplained Syncope, Oseltamivir in Critically Ill Influenza, and Prehospital Heparin in STEMI

Oct 26, 2026

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5 min read

The Hallway Consult — Issue #27: Ambulatory ECG for Unexplained Syncope, Oseltamivir in Critically Ill Influenza, and Prehospital Heparin in STEMI

This week covers three things we tend to do without much thought: send the unexplained syncope patient home with "follow up for a monitor," order Tamiflu for every flu patient going to the ICU, and wait for the cath lab to give the heparin. One trial says the monitor doesn't buy what we hoped for. One says the reflexive antiviral may be doing harm in the sickest patients. One says the earlier heparin opens more arteries.

Matthew Barmmer

The Hallway Consult — Issue #26: AI Chest Pain Triage, HINTS vs. Sudbury Vertigo Risk Score, and Thrombectomy for Medium/Distal Vessel Occlusion Stroke

Oct 19, 2026

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5 min read

The Hallway Consult — Issue #26: AI Chest Pain Triage, HINTS vs. Sudbury Vertigo Risk Score, and Thrombectomy for Medium/Distal Vessel Occlusion Stroke

This week's issue is a check on three tools we lean on to sort high-stakes undifferentiated patients: an AI tool for troponin interpretation, two competing frameworks for the dizzy patient, and thrombectomy for the stroke subtype that keeps failing to show benefit. One of these is a genuine win for triage efficiency. Two are reminders that a tool being safe, or biologically plausible, is not the same as a tool changing outcomes.

Matthew Barmmer

The Hallway Consult — Issue #25: Cooling Duration After Cardiac Arrest, Post-Arrest Oxygen Targets, and Catheter-Directed Thrombolysis for PE

Oct 12, 2026

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5 min read

The Hallway Consult — Issue #25: Cooling Duration After Cardiac Arrest, Post-Arrest Oxygen Targets, and Catheter-Directed Thrombolysis for PE

This week's issue is about post-resuscitation and PE care getting more precise answers than we've had in years. Two large cardiac arrest trials each knock down a long-standing assumption — longer cooling, tighter oxygen control — and a third finally gives catheter-directed therapy for intermediate-high-risk PE the clean trial it's lacked. Three trials, three practices worth reconsidering before your next code or PE workup.

Matthew Barmmer

The Hallway Consult — Issue #24: Capillary Refill–Guided Resuscitation, Tenecteplase Before Thrombectomy, and Steroids for Pneumonia

Oct 5, 2026

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5 min read

The Hallway Consult — Issue #24: Capillary Refill–Guided Resuscitation, Tenecteplase Before Thrombectomy, and Steroids for Pneumonia

This week's issue is a study in restraint. A bedside sign everyone already checks gets a rigorous trial and comes back murkier than hoped. A drug that works brilliantly early in stroke gets tested later in the window and adds nothing. And an intervention with a mixed track record finally gets a clean, adequately powered answer — just not in the population you'd expect. Three trials, three different lessons about when more intervention helps and when it doesn't.

Matthew Barmmer