One of the most challenging and amazing aspects of Emerg Med (Los Angel) is the shear breadth of potential pathology and topics that Emerg Med (Los Angel) physicians may encounter on any particular shift and throughout their careers. This same factor attracts some medical students to the specialty, horrifies others and draws both contempt and appreciation from colleagues who specialize in a narrow focus. In fact, a common question from colleagues is just how we can hope to keep up with so many different topics? Conversely, others such as young physician extenders sometimes feel that everything one has to know is so superficial that its mastery can be attained with much shorter training.

In answer to questions and criticisms alike, one has to only look at this issue of Emerg Med (Los Angel) . The topics range from anaphylaxis, to ECG changes in pericarditis to traumatic head injury [1-3]. Rare pathology such as panhypopituitarism are not left off and show that not only does Emerg Med (Los Angel) encompass a great breadth of disease, but depth as well [4]. Taking just two of the manuscripts in this issue, sepsis and traumatic brain injury, one quickly realizes that Emerg Med (Los Angel) is in the center and on the front lines of the biggest topics and challenges in medicine. We are forced to develop “diagnostic and therapeutic algorithm for the hypoperfused patient with septic shock in the emergency department” and do not simply borrow from other specialists who treat such patients [5]. Many patients with hyperkalemia are saved or lost in the emergency department and we study “Predictors of Outcome in Patients Presenting with Moderate to Severe Hyperkalemia” [6]. Anaphylaxis occurring in the general population, especially for the first time, presents to emergency physicians who are responsible to know pathophysiology and multiple treatment options [1].

In summary, Emerg Med (Los Angel) is an incredible look at the front lines of medical care that has no boundaries in organ system or disease pattern. This issue of Emerg Med (Los Angel) Open Access presents multiple cutting edge cases and reviews which illustrate the science of Emerg Med (Los Angel) practice and capture the many cutting edge interventions available to the modern Emerg Med (Los Angel) practitioner.