EM Guideline Updates: Practical Take-Home Changes with Dr. Michael McCrea

So the lecture I gave this morning was called 2AM Guideline Updates.

And it kind of developed organically as an academic faculty member.

It's kind of our job to stay up to date on Everything, we teach the residents and also for our own practice.

And over the last couple of months, we realized that in the last year, we have had major updates to ACLS, PALS, the every five-year updates from the AHA.

Earlier this year, we had the fundamental paradigm shift in how we categorize, work up, and treat PE.

And we had the updates from the AHA and the ASA on ischemic stroke.

And then finally, we also had a new ASAP clinical policy on aortic dissection.

So instead of, you know, making this like a journal club lecture, I wanted to just, you know, what are the high points? What are the take home messages? A couple from each of those topics for practicing docs in the community, something you can take to the bedside.

And that's why I called it 2AM.

And I love the way that you put the ACLS PALS, you know, they're designed for everyone and that it's a starting point for us in the world of emergency medicine.

So it's kind of that initial foundation that we all end up doing.

But of course, we move way past that with our board certification.

So let's talk about those updates on ACLS and PALS.

Sure.

So ACLS and PALS, the AHA and all the other organizations, about every five years, they come out with those comprehensive guideline updates that start with the old core recommendations and then the different societies.

And nothing breaking news, nothing fundamental, not like... years ago when we got rid of three-stack shocks, or we went from ABC to CAB, right? Nothing that interesting.

But some of the things that I picked out for docs to take home, we have a new algorithm for the first time in 10 years for tachycardia.

So they updated the tachycardia algorithm in part.

They had taken some things off in terms of the cardioversion doses depending on was it wide, was it narrow, was it regular, irregular, And in 2020, in 2025, it just says, refer to the manufacturer's recommended dose.

Well, that's not clinically helpful if you don't have your manual nearby.

In 2020, so in 2025, they added, if you're not sure, use the maximum dose.

So that is something you can take home.

You don't have to do a rhythm analysis.

The patient's unstable.

Synchronized cardioversion.

So the lecture I gave this morning was called 2AM Guideline Updates.

And it kind of developed organically as an academic faculty member.

It's kind of our job to stay up to date on Everything, we teach the residents and also for our own practice.

And over the last couple of months, we realized that in the last year, we have had major updates to ACLS, PALS, the every five-year updates from the AHA.

Earlier this year, we had the fundamental paradigm shift in how we categorize, work up, and treat PE.

And we had the updates from the AHA and the ASA on ischemic stroke.

And then finally, we also had a new ASAP clinical policy on aortic dissection.

So instead of, you know, making this like a journal club lecture, I wanted to just, you know, what are the high points? What are the take home messages? A couple from each of those topics for practicing docs in the community, something you can take to the bedside.

And that's why I called it 2AM.

And I love the way that you put the ACLS PALS, you know, they're designed for everyone and that it's a starting point for us in the world of emergency medicine.

So it's kind of that initial foundation that we all end up doing.

But of course, we move way past that with our board certification.

So let's talk about those updates on ACLS and PALS.

Sure.

So ACLS and PALS, the AHA and all the other organizations, about every five years, they come out with those comprehensive guideline updates that start with the old core recommendations and then the different societies.

And nothing breaking news, nothing fundamental, not like... years ago when we got rid of three-stack shocks, or we went from ABC to CAB, right? Nothing that interesting.

But some of the things that I picked out for docs to take home, we have a new algorithm for the first time in 10 years for tachycardia.

So they updated the tachycardia algorithm in part.

They had taken some things off in terms of the cardioversion doses depending on was it wide, was it narrow, was it regular, irregular, And in 2020, in 2025, it just says, refer to the manufacturer's recommended dose.

Well, that's not clinically helpful if you don't have your manual nearby.

In 2020, so in 2025, they added, if you're not sure, use the maximum dose.

So that is something you can take home.

You don't have to do a rhythm analysis.

The patient's unstable.

Synchronized cardioversion.