Acute otitis media is among the most common childhood infections and a major source of antibiotic use. Evidence from randomized trials shows that around 80% of cases resolve spontaneously, with antibiotics offering only modest symptomatic benefit and causing frequent adverse effects. Watchful waiting-with accurate diagnosis, effective analgesia, and clear safety-netting-achieves equivalent outcomes to immediate treatment in most children. Antibiotics remain essential for infants aged under 6 months, bilateral or suppurative disease, and high-risk groups. Aligning practice with evidence supports safer, more rational care and helps mitigate antimicrobial resistance.

Fever is one of the most common reasons for pediatric emergency visits, yet misconceptions continue to shape caregiver behavior and clinical practice. This review examines 5 common myths and misconceptions: (1) fever is harmful, (2) higher fever signals more severe illness, (3) antipyretics prevent febrile seizures, (4) clinical improvement after antipyretics rules out serious infection, and (5) alternating antipyretics is superior to monotherapy. Emergency medicine clinicians should prioritize distress-relieving care, careful assessment for serious illness, and effective caregiver education to reduce fever phobia and promote safe, evidence-based use of antipyretics.

Epinephrine use in cardiac arrest (CA) is associated with a greater likelihood of return of spontaneous circulation (ROSC) but this early potential benefit does not seem to translate to survival with good neurologic outcomes. Similarly, high-dose epinephrine may yield a small increase in ROSC but does not improve rates of hospital discharge, long-term survival, or improved neurologic outcomes compared to standard-dosed epinephrine. Higher cumulative doses of epinephrine (>3 mg) during CA has been consistently associated with poor neurologic outcomes following ROSC.

Premedication protocols are common in the Emergency Department (ED) before intravenous contrast-enhanced computed tomography scans to prevent adverse reactions to the contrast media. Such protocols arose due to the complications related to the high-osmolality contrast used 40 years ago, not the modern low-osmolality contrast, which carries a significantly lower risk of adverse reactions. Established regimens call for hours-long premedication protocols, which are often not feasible for emergency physicians due to the time-sensitive nature of ED evaluation. This article reviews the evidence (or lack thereof) for benefits related to premedication, while also considering the potential harms.

The teaching that ketamine should be avoided in patients suffering from a traumatic brain injury (TBI) has been a long-held dogma due to a fear of increased intracranial pressure (ICP). However, this recommendation was not based on data in patients with TBI. Ketamine holds several neuroprotective properties that may be beneficial in this group of patients. Additionally, in contemporary studies that were better controlled, ketamine has not been shown to significantly increase ICP in patients with TBI. In fact, ketamine may decrease ICP and increase cerebral perfusion pressure.

There has long been concern regarding cross-reactivity between penicillin and cephalosporin allergies, with historical sources citing rates up to 10%. More recent assessment of later-generation cephalosporins suggests a cross-reactivity rate closer to 1%. Clinical guidance is inconsistent, with some advising blanket avoidance of cephalosporins, whereas more recent specialist guidance supports a nuanced, risk-stratified approach. Shared decision-making and individual risk assessment are recommended, with a role for formal allergy testing and incremental dosing in some cases.

Influenza is a significant global health concern, with millions of cases, hospitalizations, and deaths annually, particularly impacting older adults and children. Antivirals like neuramidase inhibitors (oseltamivir, zanamivir, and peramivir) and endonuclease inhibitors (baloxavir) can help with treatment when started within 48 hours of symptom onset, primarily shortening illness duration by about 1 day. They should also be considered for treatment of hospitalized, severely ill, or high-risk patients (ie. elerly, pregnant and immunocompromized). However, for healthy, low-risk outpatients, the clinical benefit is modest, adn the risk of side effects is high.

Modern evidence has largely discredited the long-held belief that intravenous contrast routinely causes nephropathy. Early studies with high-osmolality agents and no controls suggested "contrast-induced nephropathy," but recent research using controlled cohorts shows contrast is rarely the direct cause of acute kidney injury (AKI). Guidelines now favor the term "contrast-associated AKI," emphasizing correlation over causation. In patients with estimated glomerular filtration rate 30 mL/min or greater, contrast can be safely used without delay or prophylactic hydration. Overly cautious policies delay diagnosis and harm patient care, especially in emergency settings. Contrast should be viewed as a vital diagnostic tool, not a toxin.

The authors examine 3 controversies in pediatric fracture management. The first is the use of point-of-care ultrasound versus radiography for buckle fractures. The second is the need for immobilization for stable distal radius fractures. The third is the role of using a cast or splint versus no immobilization in the management of toddler's fractures. Recent evidence supports potentially more minimalist approaches. The use of ultrasound, soft bandaging, and nonimmobilization can be as effective as traditional methods.

Corneal abrasions are some of the most common ocular complaints seen in the emergency department and are associated with significant discomfort. Although simple corneal abrasions usually heal within 2 to 3 days, treatment is often needed to help alleviate the pain. The prescribing of topical anesthetics historically has been strongly discouraged due to concerns for complications such as corneal melting and scaring. Here, we review the evidence behind this long-standing concern and propose a potentially safe role for short-term topical anesthetic use.

Orthostatic vital signs (OVS) have long been a routine part of volume assessment in the emergency department. However, recent evidence demonstrates poor sensitivity and specificity for detecting moderate hypovolemia, with high variability across patient populations. This article reviews the physiologic basis, diagnostic limitations, and alternative methods for assessing intravascular volume, including point-of-care ultrasound and dynamic indices. Ultimately, OVS remain a simple bedside adjunct but should be interpreted cautiously and within the broader clinical context.