Top Ten Most Viewed Posts in 2025

Written by Clay Smith

Spoon Feed
Here are the top ten most viewed JournalFeed posts in 2025 (from our Google Analytics data). I’ve dropped a comment on how each article has impacted me this year. Enjoy!

10, 9, 8, 7…

1. New 2025 AHA/ACC Hypertension Guidelines
   • The 2025 AHA/ACC hypertension guidelines recommend a universal BP goal of <130/80 with antihypertensive therapy initiation, guided by hypertension severity, comorbidities, and PREVENT risk score.
   • Comment: This affirms my practice of starting with amlodipine +/- adding an ARB in some patients.
   • 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Hypertension. 2025 Aug 14. doi: 10.1161/HYP.0000000000000249. Epub ahead of print. PMID: 40811516.
2. New Sudbury Vertigo Risk Score Derivation
   • The Sudbury Vertigo Risk Score helps identify patients with vertigo who are at risk for stroke. It has remarkable sensitivity for serious neurologic pathology but has yet to be validated.
   • Comment: It’s important to note the external validation study, though the datasets from derivation and validation appear to overlap, so view this with caution.
   • Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department. Ann Emerg Med. 2025 Feb;85(2):122-131. doi: 10.1016/j.annemergmed.2024.06.003. Epub 2024 Aug 1. PMID: 39093245
3. How to Intubate in 2025 – The Best Current Evidence
   • 40% of patients undergoing endotracheal intubation (ETI) have a major adverse event. This article gets you up to speed on what tools, techniques, drugs, and interventions give your patient the best shot to intubate successfully without adverse events.
   • Comment: I was surprised the complication rate is that high. This is a very important read for anyone who intubates in the ED.
   • Evidence-based Emergency Tracheal Intubation. Am J Respir Crit Care Med. 2025 Apr 16. doi: 10.1164/rccm.202411-2165CI. Epub ahead of print. PMID: 40238943
4. Wait… NO Rh Testing or RhIg Under 12 Weeks?
   • American College of Obstetrics and Gynecology (ACOG) recommends foregoing routine Rh screening and RhIg prophylaxis for patients undergoing abortion or experiencing pregnancy loss at less than 12 weeks gestation.
   • Comment: Note this important caveat from ACOG: “…studies to date have not reported on the main clinical outcomes of interest: development of Rh alloimmunization and HDFN in subsequent pregnancy.” If planning future pregnancy, I will discuss with the patient, err on the side of caution, and recommend it. What’s the downside?
   • Rh D Immune Globulin Administration After Abortion or Pregnancy Loss at Less Than 12 Weeks of Gestation. Obstet Gynecol. 2024 Dec 1;144(6):e140-e143. doi: 10.1097/AOG.0000000000005733. Epub 2024 Sep 10. PMID: 39255498
5. STANDING Algorithm for Vertigo – How Accurate Is It?
   • In ED patients with vertigo, the STANDING algorithm had high diagnostic accuracy and negative predictive value for central causes while reducing CT imaging and length of stay compared to “usual care.” However, the main caveat here was that these emergency physicians underwent dedicated training in the algorithm.
   • Comment: I hate vertigo. It makes my soul die a little every time I see it on the track board. Whether STANDING, Sudbury, or HINTS, you need formal training to learn these methods.
   • Diagnostic Accuracy of the STANDING Algorithm in Patients with Isolated Vertigo: A Multicentre Prospective Study (STANDING-M). Emerg Med J. 2025 Jul 29. doi: 10.1136/emermed-2025-214902. PMID: 40730460.
6. C-Collars and Backboards Do More Harm than Good?
   • The National Association of EMS Physicians (NAEMSP)’s comprehensive review of spinal motion restriction in prehospital management of trauma concluded that cervical collars and backboards are more likely to harm patients than to prevent delayed neurological injury (DNI).
   • Comment: I spoke to our local Nashville/Davidson County EMS Medical Director, Jared McKinney, about this on shift. He mentioned that since a rigid collar is the inpatient standard of treatment for most c-spine fractures, it’s hard to imagine we should do less in the field when we don’t know whether a fracture is present.
   • Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries – A NAEMSP Comprehensive Review and Analysis of the Literature. Prehosp Emerg Care. 2025 Aug 7:1-13. doi: 10.1080/10903127.2025.2541258. Epub ahead of print. PMID: 40736221.
7. Epinephrine 0.3mg or 0.5mg for Anaphylaxis?
   • For anaphylaxis in adults ≥50kg, 0.5mg vs. 0.3mg IM epinephrine is strongly associated with a reduction in escalation of care (repeat epi, epi drip, or intubation).
   • Comment: For most normal-sized adults, we should use 0.5 mg. It makes sense from a weight-based dosing perspective and appears more effective.
   • Retrospective comparison between 0.3 mg and 0.5 mg dosing of intramuscular epinephrine for anaphylaxis. Am J Emerg Med. 2025 Oct 10;99:270-275. doi: 10.1016/j.ajem.2025.10.020. Epub ahead of print. PMID: 41106150.
8. ABG or VBG to Rule Out Hypercarbia?
   • This article summarizes data supporting use of venous blood gas (VBG) screening for hypercarbic respiratory failure rather than an arterial blood gas (ABG).
   • Comment: VBGs are useful for screening, since a PvCO₂ <45 mmHg ruled out hypercarbia with 100% sensitivity. Most of the time, we don’t need an ABG.
   • Things We Do for No Reason™: Arterial blood gas testing to screen for hypercarbic respiratory failure. J Hosp Med. 2025 Sep;20(9):1002-1004. doi: 10.1002/jhm.70039. Epub 2025 Apr 4. PMID: 40183604; PMCID: PMC12406756.
9. Disappearing STEMI – Prehospital Post-ROSC STEMI Is Suspect
   • Out-of-hospital cardiac arrest patients with prehospital post-ROSC STEMI on ECG often don’t have STEMI on ECG in the ED.
   • Comment: It’s hard to ignore a post-ROSC STEMI on EMS ECG. My take-home is to focus on other important post-ROSC interventions first and do the ECG a bit later.
   • Associations with resolution of ST-segment elevation myocardial infarction criteria on out-of-hospital 12-lead electrocardiograms following resuscitation from cardiac arrest. Resuscitation. 2025 Apr;209:110567. doi: 10.1016/j.resuscitation.2025.110567. Epub 2025 Mar 6. PMID: 40057016
10. EM Pharmacotherapy Literature of 2024
    • This article reviewed major ED pharmacotherapy studies from 2024, including topics such as anticoagulation reversal, seizure prophylaxis in TBI, and thrombolysis in ischemic stroke.
    • Comment: This was just a helpful, practical post. I hope they do a “Best of 2025” article!
    • CuratED: The emergency medicine pharmacotherapy literature of 2024. Am J Emerg Med. 2025 Jul;93:146-153. doi: 10.1016/j.ajem.2025.03.046. Epub 2025 Mar 24. PMID: 40203497