This is the main page for a new WikEM piloting a new section, called WikEM-Now. Frequently, there are legitimate disagreements about what it the best management of a particular problem based on available literature. The way such debate traditionally (and mostly still) works is that there are articles back in forth in journals and then (maybe) standard textbooks give their opinion or a medical society comes up with some guideline.

However, in all of these, a select (small) group of people give their opinion and there are always concerns about the impartiality of these select journal and text writers or those on the committees. Cochran, the NNT, and other such lit reviewers are perhaps less biased, but are similar in that a small select group (or sometimes just an individual) is telling everyone else what to do. This approach is top down and very last century, although still the predominant model.

For web 2.0+, you can add in the blogs and social media, which function like the journal articles of prior, accept have more people contributing than could be found in the journals. These sites do not have to get "peer reviewed," so it is more democratic. However, this approach causes more chaos and it is hard to say what is the majority (as opposed to the loudest) opinion. These sites also provide little utility in the search for quick management decisions.

Wikipedia has another method, in that they want to come to a page that is neutral with both opinions (e.g. the Israli-Palistinian Conflict). However, many doctors come to WikEM because they want a usable answer "now," not a several page discussion of the literature (although it is good to also have that also available). It is nice to know, when you are alone in your ED, what your colleagues reading the same information would do (i.e. WikEM-Now).


WikEM-Now will attempt to turn the guideline world upside down with a new, collaborative way of developing concrete management guidelines. It will be the first time that the majority of emergency medicine pracitioners get to vote/contribute to their own guidelines.

The plan is to:

  • Identify/flag controversial issues
  • Have as many contributors as interested make an "Evidence Based Lit Review" page for the clinical question on WikEM
    • the page should have both pro and con argument
    • the page should be neutral (the "Wikipedia goal")
  • Then, all WikEM users will have the opportunity to read the Lit Review and vote on which option they will choose in practice, based on the current evidence. We will be sending out a notice of the vote via our blog/apps and there will be one vote per WikEM username.
  • Once we have a winner, in addition to sending out the result on the blog/app, we will then highlight the winning opinion (with total votes and percentage of vote for each option) at the top of the Lit Review page (the "take home message," similar in format as done in Annals of EM lit review articles). This option will also be the first one used/highlighted in the related clinical note, with a link to the relevant WikEM-Now page.

WikEM Now Rules

Please edit the page to improve the arguments on both sides.

You are encouraged to:

  • Improve the pro/con arguments
  • Add literature citations and summaries
  • Write for both pro and con positions (to improve the logic/writing of both sides of the argument)
  • Add additional scenarios, if necessary


  • Edit the article to worsen the "other side's" argument
  • Use non-professional language

Potential Topics