EM Quick Hits 71 EMC²: Fever Without a Source, Coaching the EM Mind Part 1, Traumatic Pneumothorax Part 2, PECARN C-spine Rule, Medetomidine Withdrawal, EMS Handover

Emergency medicine clinical practice requires a nuanced approach to diagnostic uncertainty, procedural management, and professional sustainability. Fever of unknown origin necessitates a broad differential, including rare viral etiologies like West Nile virus, while traumatic pneumothorax management relies on patient stability to dictate the use of pigtails versus large-bore chest tubes. Emerging drug trends, such as medetomidine contamination in the unregulated opioid supply, demand vigilance for refractory withdrawal symptoms requiring alpha-2 agonist replacement. Clinical decision rules like the PECARN C-spine criteria offer high-quality data but risk increasing unnecessary imaging when misapplied outside of high-risk trauma centers. Standardizing handovers with the IMIST-AMBO framework improves patient safety by reducing communication gaps. Finally, career longevity in high-stress environments depends on prioritizing physiologic needs—sleep, nutrition, and fitness—to mitigate the cumulative impact of shift work and prevent burnout.