September 28, 2026 – October 4, 2026
Weekly Roundup
28 resources from 9 sources were added to the FOAM Cortex library this week and are now indexed. Explore a selection below, with links to the original educators.
10 highlights · 8 featured sources
EM@3AM: Leadless Cardiac Pacemakers
This emDOCs EM@3AM review covers leadless cardiac pacemakers (LCPs), highlighting that they appear as small radiopaque objects on x-ray (no chest wall generator), produce an LBBB-pattern ECG when pacing from the right ventricle, and that pacing spikes are often absent or subtle. A key management pearl is that Medtronic LCPs are unaffected by magnets, while Abbott devices respond differently; transcutaneous or transvenous pacing can temporize if an LCP fails.
Ep 299 - Which patients with chest pain need a troponin?
In this St Emlyn's episode, Prof. Rick Body draws on his own cohort studies to show that individual symptoms, typicality classifications, cardiovascular risk factors, and clinician gestalt each perform poorly as standalone tests for MI—for example, absent risk factors still carried a ~10–12% MI probability, and "definitely not ACS" gestalt was wrong 5% of the time in a multicentre study. His practical approach is to test troponin whenever a convincing alternative explanation is absent and MI remains plausible.
Ready or Not – Pediatric Emergency Readiness Saves Lives
A JAMA Pediatrics observational study found that losing or lacking high ED pediatric readiness and inpatient pediatric services were each independently associated with higher pediatric mortality, suggesting both factors contribute separately to excess child deaths. Study design and causality limitations should be considered when interpreting these associations.
Finger on the Pulse: Personalizing Sepsis Resuscitation in 2026
This Grand Rounds review of personalized sepsis resuscitation highlights ANDROMEDA-SHOCK 2 (NEJM 2025), in which CRT-guided resuscitation was associated with a win ratio of 1.16 over lactate-guided care—driven by reduced organ dysfunction rather than a mortality difference—and outlines a bedside CRT-PHR algorithm incorporating PLR, DBP targets, and POCUS LV assessment after initial resuscitation.
HipPEMcrates FOAM Roundup | September 2026
This September 2026 HipPEMcrates roundup organizes 29 PEM FOAM resources by clinical use, covering topics including lung-exam interobserver reliability in pneumonia, PERC-Peds/BEEPER for pediatric PE risk stratification, FPIES as a mimic of gastroenteritis, hair-tourniquet removal, steroid stewardship in asthma, and pediatric DVT management. Key recurring themes are avoiding single-finding diagnoses, matching evidence strength to clinical decisions, and ensuring reassessment and clear discharge planning.
Before ECPR: Optimising Shockable Cardiac Arrest at The Big Sick.
A conference session at The Big Sick (Zermatt) reviewed expert-panel consensus on optimising shockable cardiac arrest before considering ECPR, covering strategies such as pre-charging defibrillators, minimising hands-off time, correct anterolateral pad placement, vector-change defibrillation, and DSED. Panellists noted most points lack rigorous RCT support and remain outside current ERC guidelines, emphasising these as areas for future evidence rather than immediate practice changes.
ALiEM AIR Series | Ortho Spine Module (2026)
The ALiEM AIR Ortho Spine Module (2026) curated six high-quality online posts on emergency orthopedic spine topics from the top 50 FOAMed sites over 11 months, awarding two AIR stamps (EMCrit posts on spinal cord injury and spinal epidural abscess) and four Honorable Mentions covering cervical myelopathy, blood pressure targets in acute spinal cord injury, TENS for back pain, and pediatric spinal injuries.
An RCT of heparin in STEMI
The HEPARIN-STEMI RCT (single-center, open-label, n=598) found prehospital UFH was associated with higher rates of TIMI 2–3 flow at initial angiography (43% vs. 27%), but post-procedural flow and all clinical outcomes including 1-year mortality were unchanged. The author cautions that the unblinded design, subjective primary outcome, and unexplained exclusion of nearly half of eligible patients limit confidence in these findings.
How to Use POCUS for Pleural Effusion
The source content is truncated and contains only a citation and teaser text, with no substantive findings, teaching points, or clinical details available to summarize.
Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism
In this open-label, blinded-endpoint RCT (Castellucci et al., NEJM 2026), apixaban was associated with significantly lower 3-month clinically relevant bleeding than rivaroxaban (3.3% vs. 7.1%; RR 0.46) in adults with acute VTE, with similarly low recurrent VTE rates. Limitations include open-label design, exclusion of patients over 120 kg or with active cancer, and only 3-month follow-up.
New to the library does not necessarily mean newly published. This roundup features public resources added during the week and successfully indexed by the time the issue was prepared. Follow the links to read or listen at the original source.