Emergency medicine pharmacotherapy literature of 2025

The purpose of this article is to summarize pharmacotherapy-related emergency medicine (EM) literature indexed in 2025. Articles were selected using a modified Delphi approach. The table of contents from predetermined journals were reviewed and independently evaluated via the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system by paired authors. Pharmacotherapy-related publications deemed to be GRADE 1A and 1B were reviewed by the collective group for inclusion in the review. This article synthesizes and evaluates findings from 7 randomized controlled trials, 10 guidelines, clinical policies, position statements, or consensus recommendations, and 11 meta-analyses, providing critical insight into their potential clinical impact. Covered topics include guideline or policy updates on advanced cardiac life support, rapid sequence intubation, tranexamic acid in trauma, acute coronary syndromes, and hypertension. Randomized controlled trials covering sedative use in rapid sequence intubation, treatment of sexually transmitted infections and bacterial vaginosis, sodium bicarbonate for severe acidemia and acute kidney injury in the critically ill, and thrombolytic therapy beyond traditional time windows for ischemic stroke are also reviewed. Additional topics include nebulized and low-dose ketamine for analgesia, erector spinae plane block for renal colic, two-bag versus three-bag acetylcysteine regimens for acetaminophen overdose, QT prolongation in antipsychotic overdose, and naltrexone for opioid dependence.