#ICEM2025 May 27th Recap!
- Shahbaz Syed
- 6 days ago
- 31 min read
Updated: 6 days ago
Day 3 brought the energy – and the heart – of the emergency medicine community to the forefront. Docs That Rock the night before was a highlight, reminding us that behind every resuscitationist is a rock star in disguise.
The room was electric, and in true Montréal fashion, the night closed with a spontaneous and spirited “Olé, Olé, Olé” chant that brought everyone to their feet.
The clinical content today matched the atmosphere – practical, cutting-edge, and deeply human. Here are the top takeaways from every part of the conference.
🌟 Plenary Session One: Defining and Delivering EM in Developing Countries
Speakers: Dr. Yeisey Yadkinnie Cruaz, Dr. Olita Shilpakar, Dr. Lise Mumporeze, moderated by Dr. Aisha Terry
🌟 Plenary Session Two: Defining and Delivering EM in Developing Countries
Speakers: Dr. Don Melady
🩺 Morning Concurrent Tracks
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Speaker: Dr. Claire Heslop
PoCUS Pokes
Point-of-care ultrasound (POCUS) has become an essential tool in emergency medicine—not just for diagnostics, but for enhancing procedural accuracy, pain control, and patient safety. This high-yield session explored practical applications of ultrasound to improve nerve blocks and vascular access in the ED.
🦴 Block the Hip: Ultrasound-Guided Fascia Iliaca Block
Ultrasound-guided nerve blocks are now standard of care for patients with hip fractures in many settings—including Ontario’s provincial hip fracture quality standard.
Why do it?
Provides excellent pain relief
Associated with lower morbidity and mortality
Reduces risk of:
Delirium (NNT = 14)
Infection (NNT = 7)
How to do it:
Use an in-plane technique for needle alignment with the probe
Identify the fascia iliaca—watch for muscle-fascia separation during test dosing
Recommended anesthetic mix:
20 cc 0.5% bupivacaine
10 cc lidocaine with epinephrine
1 mL dexamethasone (prolongs block duration)
🫁 Block the Chest Wall: Serratus Anterior or Erector Spinae Block
These chest wall nerve blocks are effective for:
Rib fractures
Chest tubes
Herpes zoster
Key clinical point:
Elderly patients face increasing mortality with each rib fracture. Regional anesthesia can reduce morbidity by up to 40%.
Erector spinae block tip:
Freezes ~4 ribs above and below the injection site. A practical and straightforward addition to your analgesia toolkit.
💉 Master the IV: Ultrasound-Guided Peripheral Access
Up to 30% of ED patients have difficult IV access. POCUS is a game-changer—but only when used with intention.
Top 3 tips:
Sit down – take your time
Be picky – aim for veins ≤1 cm deep and ≥1 cm wide
Line up – pre-map the vein, especially for out-of-plane approaches
Technique:
Out-of-plane: Never lose sight of your needle tip
In-plane: Preferred by most for direct visualization of needle path
Final Thought
Whether you’re blocking a hip, numbing a rib, or placing a tricky IV, POCUS isn’t just a “nice-to-have”—it’s a must-have procedural enhancer.
Better pain control. Fewer complications. More confident procedures.
Speaker: Dr. Christopher Colbert
Its a Small World: Global ID on your Street Corner
What can a tour of duty in Iraq, a measles outbreak in 2024, and a case of subtle tetanus teach us about clinical vigilance and global health?
A Lieutenant Colonel in the U.S. military, with experience across continents and crises, delivered a powerful reminder: we grow not only through clinical knowledge, but by listening, traveling, sharing, and learning from others.
🦟 2007: Iraq – Dengue and the Power of the Tourniquet Test
In a case from Iraq, a tourniquet was applied to a patient’s arm—without blood being drawn—to screen for severe dengue fever.
The insight?
If petechiae develop after a tourniquet application, it can suggest capillary fragility and thrombocytopenia, raising the clinical suspicion of dengue severity. This classic test—also called the Rumpel-Leede or Hess test—is a simple but powerful bedside tool in resource-limited settings.
🧒 2024: Measles Epidemic – The Role of Vitamin A
During a measles outbreak, Koplik spots appeared 1–4 days before the classic rash. In that setting, oral vitamin A was administered for 2 days—based on longstanding but debated evidence showing it may reduce morbidity and mortality in pediatric measles cases.
This intervention, while simple, reflects the value of low-cost, high-impact care guided by global literature and context.
🫁 Extrapulmonary Tuberculosis – What Are You Missing?
One of the session’s most important takeaways:
“It’s not about what you didn’t miss—it’s about what you might have.”
Extrapulmonary TB remains under-recognized. Practitioners everywhere must remain vigilant for non-respiratory presentations of tuberculosis—especially in immunocompromised or migrant populations.
🤐 Tetanus – Look for the Grin
Infrequent but fatal, tetanus can present subtly. Watch for risus sardonicus—a fixed, exaggerated grin caused by facial muscle spasms. These early signs of tetany are easy to overlook but critical to recognize.
🌍 Final Reflections: Medicine is a Global Conversation
Whether it’s dengue in Iraq or TB in North America, medicine is strengthened when we learn from others, share experiences, and broaden our lens.
“Every day, you can move the needle—locally and globally. Interpretation, conversation, and connection are what drive better care.”
The session closed with a nod to the strength of organizations like CAEP and ICEM, where international collaboration turns stories into shared wisdom—and shared wisdom into better care.
Speaker: Dr. Dennis Cho
Evidence-Based Laceration Care
Lacerations are a common ED complaint—and one of the top sources of patient litigation, second only to fracture care. So why are we still relying on tradition over evidence?
This ICEM 2025 session tackled the most persistent myths in laceration repair and offered practical, evidence-based updates every clinician should know.
🚫 Myths to Drop — And What to Do Instead
❌ Myth: Never use epinephrine in fingers
✅ Reality: No digital ischemia has been reported from accidental 1:1000 epi injections in the fingers. Emerging evidence suggests it may actually be safe—and possibly beneficial.
❌ Myth: There’s a magic time cutoff for closing wounds
✅ Reality: There is no fixed time window. Use patient-specific factors (location, contamination, comorbidities) to decide whether to close.
❌ Myth: You must wear sterile gloves
✅ Reality: A large ICU trial showed no difference in infection rates between sterile and clean gloves. Choose what fits and functions best.
❌ Myth: Always irrigate
✅ Reality: Skip irrigation for clean wounds of the face and scalp.
Irrigation is most useful when:
Wound is contaminated
Tissue is devitalized
Injury is old or not on the face/head
And don’t stress about pressure or volume—neither affects infection, healing, or cosmesis.
💧 Irrigation: Use Tap Water, Not Sterile Saline
A Cochrane review confirms: tap water is just as effective (if not better) than sterile water or saline for wound cleansing. It’s safe, effective, and accessible.
💉 Local Anesthetics: Think Beyond Lidocaine
No difference in onset between lidocaine and bupivacaine
Bupivacaine lasts longer (~5 hours vs. 2 hours) and may be preferred for prolonged analgesia
Pain-reduction tips:
Use smaller gauge needles
Warm the solution
Pre-ice the area (RCT evidence supports it)
For digital blocks: single palmar poke is as effective as the two-poke dorsal approach (per SR & meta-analysis)
🧵 Absorbable Sutures Are Just as Good
Compared to non-absorbable sutures, absorbable options show no difference in:
Cosmesis
Infection
Patient satisfaction
Dehiscence
Best used when:
Primary care access is limited
Patients prefer not to return for removal
✨ Glue ≈ Sutures (For the Right Cases)
According to a 2022 Cochrane review:
No cosmetic difference
Less pain
Quicker repair
Slightly higher risk of dehiscence
Great option for select patients and settings—shared decision-making is key.
🧴 Stop the Antibiotic Ointment
A meta-analysis found no benefit to topical antibiotics like bacitracin or polymyxin B in terms of:
Infection rates
Healing
Cosmesis
Best practice: plain petroleum jelly is all you need for aftercare.
✂️ Empower Patients: Let Them Remove Sutures
For simple repairs, give patients clear instructions and let them take control. This promotes autonomy and avoids unnecessary follow-ups.
Final Word
Where does your practice come from—dogma or evidence?
Laceration management is full of myths. It’s time to align your approach with what the research actually shows—simpler, smarter, and safer care for both patients and providers.
Medical Education and Lifelong Learning: This track highlights evolving strategies to train, support, and sustain emergency clinicians through all stages of their careers.
Pediatric Emergency Medicine: This track focuses on the unique challenges and advances in caring for acutely ill and injured children in the emergency setting.
Planetary Health in Emergency Medicine: This track explores the intersection of environmental change and emergency care, highlighting how climate-related events, resource scarcity, and ecological disruption are shaping patient presentations and system demands.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
🩺 Afternoon Concurrent Tracks 1
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Speaker: Dr. David Lewis
Ready for your TEE time?
Transesophageal echocardiography (TEE) offers game-changing advantages in cardiac arrest care by providing real-time cardiac imaging, improving diagnostic accuracy, and reducing interruptions in CPR. While there are barriers to implementation, the potential impact on outcomes is significant.
Why TEE in Cardiac Arrest?
In the high-stakes environment of a resuscitation, TTE (transthoracic echo) often fails to deliver. Image quality can be poor, especially when chest compressions are ongoing or when using mechanical CPR devices. More critically, monitors and pulse checks may mislead.
TEE addresses these limitations by offering:
Continuous visualization of cardiac activity during CPR and ROSC
Clearer views of cardiac contractility
Direct assessment of CPR quality
Visualization of potentially reversible causes (e.g., tamponade, PE, hypovolemia)
By reducing the need to pause compressions, TEE aligns with resuscitation best practices — keeping “hands on chest” while still informing decision-making.
Core Clinical Questions TEE Can Answer
Is there any cardiac contractility?
How effective is the CPR being delivered?
Are there visible reversible causes of arrest?
Is the patient’s cardiac function changing during resuscitation?
These insights can help refine care, especially in prolonged or undifferentiated cardiac arrest cases.
Key Views to Use
Two views are most commonly used during cardiac arrest:
Mid Esophageal Four-Chamber View
Mid Esophageal Long Axis View
These views are achievable with minimal probe manipulation and provide actionable information during resuscitation.
What You Need to Start a TEE Program
Before implementing TEE in your emergency department, consider the following:
✅ Staffing:
Minimum of 2 MDs per shift trained in TEE
✅ Resources:
TEE probe with a compatible machine
Funding for maintenance and sterilization
✅ Systems Support:
Timely access to critical care and cardiology services for further management
Sufficient volume of cardiac arrest cases to support skill maintenance and program utility
Challenges & Limitations
While promising, TEE is not without barriers:
Low volume of cardiac arrest cases in some centers
Incompatibility with supraglottic airways
Cost and maintenance of equipment
Training and credentialing requirements for emergency physicians
Final Thoughts
TEE represents a powerful tool in the resuscitation arsenal. While implementation requires planning, resources, and team buy-in, the clinical benefits — from continuous cardiac visualization to improved decision-making — make a compelling case.
In resuscitation, seconds matter. TEE helps make those seconds count.
Speaker: Dr. Sean Moore and Dr. Sarah Giles
Tick Talk: Expanding Tick Borne Illnesses Core Facts
As the climate warms, tick populations are expanding, bringing with them a rise in tick-borne illnesses. Clinicians need to recognize the common presentations, understand transmission timelines, and treat promptly to reduce complications. Doxycycline remains the go-to treatment for many, but not all, tick-related infections.
The Spread of Ticks: Driven by Climate Change
Over the last 100 years, tick habitat has expanded significantly.
Warming climates increase tick survival and extend their seasonal activity.
In North America, black-legged ticks (Ixodes scapularis) are the primary vectors of tick-borne diseases.
Ticks 101
Arachnids (like spiders), ticks feed exclusively on blood.
Transmission timing matters:
Lyme disease (Borrelia burgdorferi) and anaplasmosis require ≥24 hours of attachment.
Powassan virus can be transmitted in as little as 15 minutes.
Tick Removal: Do It Right
Use forceps to grasp the tick as close to the skin as possible and pull straight up.
Leftover parts do not transmit disease, so no need for further intervention unless signs of infection develop.
Lyme Disease: When to Prophylax
Offer prophylaxis with a single dose of doxycycline 200 mg if all the following are true:
Tick bite occurred in a Lyme-endemic area
Tick is identified as a black-legged tick
Tick was attached for ≥24 hours
Prophylaxis started within 72 hours of removal
Special considerations:
Pregnant: Amoxicillin
Pediatric: Lower dose doxycycline or amoxicillin
If There’s a Rash: Treat
Erythema migrans (bullseye lesion) = Lyme diagnosis
Treat with doxycycline 100 mg BID for 10–14 days, even if prophylaxis was given.
Systemic symptoms (neuro, cardiac, or arthritic involvement) warrant 14–21 days of treatment.
Be aware of the Jarisch-Herxheimer reaction: Up to 15% of patients may experience transient symptom worsening in the first 48 hours of treatment.
Beyond Lyme: Other Tick-Borne Threats
🦠 Anaplasmosis
Increasing incidence
Presents like the flu, may affect the CNS
Treat with doxycycline
🦠 Powassan Virus
Tick-borne flavivirus
No rash
Rapid transmission (within 15 minutes)
Symptoms: Fever, headache, vomiting, myalgia
Severe cases: encephalitis or meningitis
No specific treatment
🦠 Babesiosis
Parasitic infection (like malaria)
Symptoms: Fever, headache, vomiting, fatigue
High risk in asplenic or immunocompromised patients
Doxycycline is not effective; specific antiparasitic therapy is needed
🦠 Rocky Mountain Spotted Fever (RMSF)
Symptoms: Fever, chills, malaise, arthralgias, purpuric rash
Mortality: 30% if untreated, <1% with prompt doxycycline
Treat with doxycycline immediately
Take-Home Points
✔ Climate change is expanding tick ranges and tick-borne illness risk
✔ Know which illnesses require longer attachment to transmit
✔ Doxycycline is first-line for most—but not all—tick illnesses
✔ Recognize when to treat without waiting for confirmatory testing
✔ Don’t delay—timely treatment can be life-saving
🕷 As tick seasons lengthen and cases rise, staying informed is our best defense. For every patient with a suspicious tick bite or systemic symptoms in summer, think broadly—and act fast.
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
Pediatric Emergency Medicine: This track focuses on the unique challenges and advances in caring for acutely ill and injured children in the emergency setting.
Planetary Health in Emergency Medicine: This track explores the intersection of environmental change and emergency care, highlighting how climate-related events, resource scarcity, and ecological disruption are shaping patient presentations and system demands.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
🩺 Afternoon Concurrent Tracks 2
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Fast, Fair and Compasionate: ED Approaches to Adults with Sickle Cell Pain
To read Dr. Bryan's summary in both English and French, click here.
Speaker: Dr. Katie Lin
Commonly Missed Stroke Syndromes
Up to 20% of strokes are missed — and those misses carry significant risk. Patients with non-classical symptoms, altered mental status, or posterior circulation strokes are at highest risk for delayed recognition.
Stroke Remains a Global Threat
2nd leading cause of death
3rd leading cause of disability
1 in 10 strokes occur in patients under age 50
Women, minorities, and patients with language barriers are more likely to be misdiagnosed
Why Are Strokes Missed?
Strokes may be missed when:
Symptoms are transient, non-lateralizing, or mild
There is altered mental status
The stroke involves posterior circulation
The patient is confused, uncooperative, or has low GCS
Assessing the Altered Patient
🧠 In patients with altered mental status or low GCS, consider stroke in the differential — especially when the cause is unclear.
Key exam tips:
Don’t rely on total GCS — examine each domain individually
Assess for eye tracking, neglect, and conjugate gaze
Check for asymmetric movement or brainstem reflexes
Stroke Syndromes You Don’t Want to Miss
🟠 Anterior Cerebral Artery (ACA) Stroke
May present with disinhibition or behavioural changes
Look for unilateral leg weakness
🔵 Posterior Circulation Stroke (for more, read here)
Cranial nerve abnormalities — the “Dangerous D’s”
Visual deficits, nystagmus, extraocular movement problems
Ataxia (truncal or limb)
Crossed findings: facial palsy with contralateral limb weakness
🧠 Basilar Artery Syndromes
Top of the Basilar Syndrome
Look for Collier’s sign: inability to look up
Locked-In Syndrome
Profound paralysis with only vertical eye movement preserved
Clinical Pearls
Migraine history doubles the risk of stroke
Sudden onset neurologic symptoms = stroke until proven otherwise
Be aware of biases that lead to missed diagnoses
When in doubt, escalate for advanced imaging and consultation
Conclusion:
Posterior and atypical strokes require vigilance and nuance in assessment. Don’t let the absence of focal deficits distract from the diagnosis — stroke can look subtle, especially in younger, altered, or systemically well patients.
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
Pediatric Emergency Medicine: This track focuses on the unique challenges and advances in caring for acutely ill and injured children in the emergency setting.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
Thank you to everyone who joined us for another inspiring and impactful day at ICEM 2025. From powerful plenaries to practical clinical sessions, today highlighted the global heart of emergency medicine — reminding us that our work transcends borders.
A special thank you to all our presenters, volunteers, and attendees for your energy and engagement throughout the day. We’re looking forward to seeing you tomorrow for the final day of the conference, as we wrap up an unforgettable week of learning, connection, and collaboration.
See you soon!