After almost twenty years as a doctor, constantly reading, it never ceases to amaze me how much I still don't know.  One of the highlights of my job is working with great residents who also teach me.  This week was no exception.  Here are two things I learned from our residents this week.

For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission.  Don't try to treat them as an outpatient.

Nuisance bleeding in patients with atrial fibrillation on oral anticoagulants did not portend subsequent major bleeding or increased risk for stroke/systemic embolism.

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

ACEP has taken a stand on some of the most contemporary issues within the diagnosis and management of venous thromboembolic disease in the emergency department.

In the evaluation of older patients with syncope, certain ECG abnormalities increase the risk of 30-day serious cardiac arrhythmias. These ECG abnormalities include non-sinus rhythm; multiple premature ventricular conductions; short PR interval; first degree atrioventricular block; complete left bundle branch block; and ST, T, and Q-wave abnormalities consistent with acute or chronic ischemia.

Adult patients with skeletal myopathy often have false positive high sensitivity troponin T (but not troponin i), because the assay cross reacts with skeletal muscle troponin T.

We want to promote great #FOAMed, and one of the finest medical blogs out there is Dr. Smith's ECG Blog (no relation...alas). This features some of his top posts and 5 ECG patterns you must know.

Syncope and seizure may be differentiated in two key ways.  Ten or fewer jerks favor syncope; 20 or more jerks favor seizure.  Loss of tone favors syncope.