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One of the benefits of Premium membership is the monthly top 10. Here are ten articles that have impacted my care. This month, we have a variety of articles across the spectrum of EM. Note, the heading/title of each article links to the original post.
All my best,
Clay
Clay Smith, MD
Chief Spoon-Feeder, JournalFeed
Written by Clay Smith
1. Not EXAKT-ly Correct – Pulse Ox & Skin Tone
Spoon Feed
In a large multicenter ICU study, five different pulse oximeter models overestimated oxygen saturation in patients with darker skin tones, leading to substantially higher false negative rates for hypoxemia.
Comment
We’ve covered this topic on JF several times, and each study shows the same thing: in darkly pigmented patients, the pulse oximeter reads HIGHER than it really is (i.e. it may say 92% when it is actually 89%).
Source
EXAKT Study Investigators. The impact of skin tone on performance of pulse oximeters used by NHS England COVID Oximetry @home scheme: measurement and diagnostic accuracy study. BMJ. 2026 Jan 14;392:e085535. doi: 10.1136/bmj-2025-085535. PMID: 41534914; PMCID: PMC12801414.
2. Positive Blood Culture ≠ Bacteremia: New Decision Rule
Spoon Feed
A simple 4-factor clinical decision rule accurately distinguished true bacteremia from contaminants in children with positive blood cultures, achieving 99% sensitivity while potentially reducing unnecessary hospitalizations.
Comment
Although this needs external validation, it is a helpful framework to think about how to manage positive blood cultures.
Source
Derivation and Validation of a Clinical Rule to Detect Bacteremia Versus Contaminants in Positive Pediatric Blood Cultures: A Retrospective Cohort Study. Ann Emerg Med. 2025 Dec;86(6):576-585. doi: 10.1016/j.annemergmed.2025.06.620. Epub 2025 Aug 14. PMID: 40810705..
3. Is CT Accurate for Globe Rupture?
Spoon Feed
When eye exam is limited by trauma, we rely on orbital CT. While specificity is 94%, sensitivity is only 75% for open globe injuries (OGI), making surgical consultation necessary when suspicion remains.
Comment
CT performance is lackluster. If you see open globe, it is real. If not, and you still suspect it could be, you need to call ophthalmology.
Source
Diagnostic test accuracy of CT for open globe injury: A systematic review and meta-analysis of overall impression and individual imaging signs. Injury. 2026 Jan 10;57(3):113041. doi: 10.1016/j.injury.2026.113041. Epub ahead of print. PMID: 41534455.
4. NIPPV and Lower Mortality in Severe Asthma
Spoon Feed
This retrospective, propensity-matched study of adult and pediatric patients with severe asthma confirms what we already know clinically: non-invasive positive pressure ventilation (NIPPV) decreases mortality and need for intubation.
Comment
In severe status asthmaticus, NIPPV can be life-saving.
Source
Association Between Noninvasive Positive Pressure Ventilation Use and Clinical Outcomes During a Severe Asthma Exacerbation: A Cohort Study. Crit Care Med. 2026 Jan 14. doi: 10.1097/CCM.0000000000007025. Epub ahead of print. PMID: 41532815.
5. ADJUST-DVT – Age-Adjusted Dimer for DVT
Spoon Feed
Using Wells-based pretest probability with an age-adjusted D-dimer safely ruled out lower-extremity DVT in ED outpatients with zero 3-month VTE events among patients between the conventional and age-adjusted cutoffs.
Comment
I have used age-adjusted D-dimer for PE for years. Now, I can safely use it for DVT as well.
Source
ADJUST-DVT Investigators. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis. JAMA. 2026 Feb 3;335(5):416-424. doi: 10.1001/jama.2025.21561. PMID: 41490105; PMCID: PMC12771389.
6. Lispro vs. Regular Insulin for Hyperkalemia
Spoon Feed
When comparing IV insulin lispro versus IV insulin regular for hyperkalemia in the ED, lispro was associated with a significant decrease in potassium but an increase in hypoglycemic events.
Comment
Lispro may drop K slightly more, but is also drops glucose more. I will just stick with regular insulin.
Source
Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial. Am J Emerg Med. 2025 Dec 26;101:92-98. doi: 10.1016/j.ajem.2025.12.031. Epub ahead of print. PMID: 41477935; PMCID: PMC12810486.
7. C-A-B – Resuscitate BEFORE You Intubate in Trauma
Spoon Feed
In adult trauma patients presenting with hemorrhagic shock, initiating blood transfusion prior to endotracheal intubation was associated with lower odds of 30-day mortality and less frequent postintubation hypotension (PIH).
Comment
If at all possible, try to achieve improved hemodynamic stability with hemorrhage control and blood products before intubating. This is associated with lower mortality, but this retrospective study is subject to confounding.
Source
Circulation-first trauma resuscitation and mortality: A 9-year single-center retrospective study. J Trauma Acute Care Surg. 2025 Dec 17. doi: 10.1097/TA.0000000000004850. Epub ahead of print. PMID: 41417671.
8. Necrotizing Soft-Tissue Infections – A Survival Guide
Spoon Feed
This evidence-based expert position statement on necrotizing soft tissue infections (NSTIs) provides best practices for assessment, diagnosis, treatment, antimicrobials, adjunctive therapies, and long-term management.
Comment
This is a good review of an important topic. Recommend reading this one if you missed it.
Source
Necrotizing soft-tissue infections survival guide in adult patients: A position statement by the Global Alliance for Infections in Surgery. J Trauma Acute Care Surg. 2026 Feb 1;100(2):320-331. doi: 10.1097/TA.0000000000004833. Epub 2025 Dec 17. PMID: 41417687.
9. Which RBBB Patterns Need the Cath Lab?
Spoon Feed
Patients presenting with anginal symptoms and a new right bundle branch block (RBBB) on ECG or RBBB-specific high-risk features should prompt emergent evaluation for reperfusion therapy.
Comment
This was also a nice review about when RBBB should not be seen as a benign, incidental finding.
Source
Right bundle-branch block (RBBB) and acute coronary syndrome (ACS) a narrative review. Am J Emerg Med. 2026 Jan;99:325-334. doi: 10.1016/j.ajem.2025.10.037. Epub 2025 Oct 17. PMID: 41429745.
10. Prolonged Apnea in Pediatric Intubation – Who’s At Risk?
Spoon Feed
In this ED/PICU-based cohort, infants < 12 months were more likely to have longer periods of apnea than older children. Apneic oxygenation was protective against desaturation in all ages.
Comment
Kids under a year take longer to intubate. Make sure to optimize preoxygenation every way you can, especially in younger children.
Source
Apneic time during intubation in critically ill children. Pediatr Res. 2026 Jan 13. doi: 10.1038/s41390-026-04773-3. Epub ahead of print. PMID: 41530490.
