LOOP DIURETICS SHOULD NOT BE ADMINISTERED EARLY TO ALL PATIENTS WITH ACUTE HEART FAILURE IN THE EMERGENCY DEPARTMENT - Annals of Emergency Medicine annemergmed.com/article/S019…
1/9
“B-lines = Lasix.”
It’s an easy reflex in the ED.
But a patient can have severe pulmonary congestion without being massively volume overloaded.
Before reaching for furosemide, ask: What phenotype am I actually treating?
A thread.
8/9
My bedside mental model:
Phenotype → Perfusion → Congestion → Diuretic response → Reassessment
Not:
B-lines → Lasix → Creatinine rises → Stop.
The numbers matter.
But they need physiological context.
I wrote a deeper bedside breakdown:
Not Every “Wet” patient needs lasix
Read the full article:
lifeonthefrontline.com/p/not…
If you work in emergency or critical care, follow Life on the Frontline for evidence-based concepts translated into bedside decisions.
Arihant Jain, MD retweeted
Today's Paper of the Day is:
Refractory septic shock: our updated pragmatic approach.
criticalcarereviews.com/late…
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
Arihant Jain, MD retweeted
This case report describes the electrocardiogram findings of a patient in their 40s with dizziness and presyncope after hematemesis and multiple black stools. ja.ma/4cHszNM
When shock becomes refractory, the next vasopressor isn't always the answer. Sometimes the diagnosis lies in the history you haven't revisited, the medication list you overlooked, or the second pathology hiding beneath the first.
In our latest publication in Clinical Toxicology, we describe a patient with septic shock whose persistent vasoplegia was compounded by chronic low-dose methotrexate toxicity.
The case is a reminder that refractory shock is often multifactorial and recognizing the additional contributor can be the turning point in management. Grateful to my co-authors for this collaborative work. Read here - lnkd.in/g23QZKTN
Syncope and 2:1 Atrioventricular Block in a Middle-Aged Man | JACC: Case Reports jacc.org/doi/10.1016/j.jacca…
Arihant Jain, MD retweeted
1⃣ What #echofirst view?
2⃣ What abnormality?
#POCUS #FOAMed
📽️courtesy - CASE (Phila). 2025;9(5):164-172. doi: 10.1016/j.case.2025.01.004.
Grateful to be part of it.
Welcome to our JULY 29 issue of #JACCCaseReports @JACCJournals featuring Part 2 of the EKG Challenge
jacc.org/journal/case-report….
Full PDF here:
jacc.org/doi/10.1016/S2666-0…
Thank you @aroniskn our Associate Editor for this Editor’s Page:
Clues, Not Patterns: The Electrocardiogram as a Detective Story
jacc.org/doi/10.1016/j.jacca…
@minnowwalsh
@hmkyale
@Justine_Turco
Wide-Complex Tachycardia: VT and VT Mimics
Wide-Complex Tachycardia in a Neonate
jacc.org/doi/10.1016/j.jacca…
Atypical Andersen–Tawil Syndrome in an Asymptomatic Child With Bidirectional Ventricular Tachycardia and Incipient Tachycardiomyopathy
jacc.org/doi/10.1016/j.jacca…
An Extreme Wide-Complex Tachycardia and Tremors
jacc.org/doi/10.1016/j.jacca…
Seamless Transition Between Narrow- and Wide-QRS Tachycardia Revealing Double Tachycardia
jacc.org/doi/10.1016/j.jacca…
AVNRT With Intermittent Aberrancy-Mimicking Ventricular Tachycardia: One Tachycardia, Two QRS Morphologies
jacc.org/doi/10.1016/j.jacca…
Atrial Tachycardia and Bundle Branch Re-Entry Ventricular Tachycardia with Similar QRS Complex Morphology
jacc.org/doi/10.1016/j.jacca…
Irregularly Irregular Wide Complex Tachycardia: Look Beyond the Atrium
jacc.org/doi/10.1016/j.jacca…
Ventricular Tachycardia or Not?: Decoding Post-Cardioversion Wide Complex Tachycardia in a CRT-D Patient
jacc.org/doi/10.1016/j.jacca…
Device Interrogation Unmasking Flecainide-Induced Wide Complex Tachycardia
jacc.org/doi/10.1016/j.jacca…
Wide QRS Tachycardias With Syncope: Two for One?
jacc.org/doi/10.1016/j.jacca…
ST-Segment Deviation Patterns and STEMI Mimics
Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI
jacc.org/doi/10.1016/j.jacca…
Atrial Repolarization as a Rare Mimicker of ST-Segment Elevation Myocardial Infarction: Revisiting Ta
jacc.org/doi/10.1016/j.jacca…
Reading the ECG in Time: Ta-Wave Pseudo-STEMI and Crochetage Sign in Adult Congenital Heart Disease
jacc.org/doi/10.1016/j.jacca…
Shark-Fin Pattern in aVR Lead as First Manifestation of Acute Left Main Coronary Artery Occlusion
jacc.org/doi/10.1016/j.jacca…
“Left Main” Pattern Electrocardiogram: A Diagnostic Trap for Cardiologists
jacc.org/doi/10.1016/j.jacca…
Isolated Cardiac Rhabdomyoma With Marked ST-Segment Elevation: Benign Tumor, Malignant ECG
jacc.org/doi/10.1016/j.jacca…
Midventricular Hypertrophic Cardiomyopathy With Apical Aneurysm Presenting as Persistent ST-Segment Elevation Mimicking Acute Myocardial Infarction
jacc.org/doi/10.1016/j.jacca…
ST-Segment Elevation Caused by Lung Cancer Mimicking STEMI
jacc.org/doi/10.1016/j.jacca…
ST-Segment Elevation in a Patient With Vocal Cord Cancer: A Great Mimicker
jacc.org/doi/10.1016/j.jacca…
A Dangerous Wave: Recognizing the Shark-Fin ECG Sign in STEMI
jacc.org/doi/10.1016/j.jacca…
Atrioventricular Block and Conduction
A Premature Ventricular Complex as Both Culprit and Cure: Paroxysmal Intrinsic Atrioventricular Block
jacc.org/doi/10.1016/j.jacca…
Progressive Conduction Disease in a Mitochondrial Disorder
jacc.org/doi/10.1016/j.jacca…
From Ophthalmoplegia to Multilevel Atrioventricular Block: Timing Cardiac Device Therapy in Kearns–Sayre Syndrome
jacc.org/doi/10.1016/j.jacca…
Syncope and 2:1 Atrioventricular Block in a Middle-Aged Man
jacc.org/doi/10.1016/j.jacca…
Idiopathic 2:1 AV Block With Ventriculophasic Sinus Arrhythmia in a Young Male
jacc.org/doi/10.1016/j.jacca…
Mobitz Type I Progressing to High-Grade AV Block: Beyond Wenckebach
jacc.org/doi/10.1016/j.jacca…
Intermittent Simultaneous Antegrade Dual Nodal Conduction With Progressive Rate-Dependent Aberrancy
jacc.org/doi/10.1016/j.jacca…
Dual Atrioventricular Nodal Physiology in Sinus Rhythm: An Extraordinary Manifestation of a Common Substrate
jacc.org/doi/10.1016/j.jacca…
The Double Fire Phenomenon With Alternating Right Bundle Aberrancy
jacc.org/doi/10.1016/j.jacca…
Atrial Activation and the PR Interval: Pre-excitation and Impulse-Origin Puzzles
The Many ECG Faces of Wolff-Parkinson-White Syndrome
jacc.org/doi/10.1016/j.jacca…
Left Ventricular Hypertrophy With Pre-Excitation: Thinking Beyond the Usual Hypertrophic Cardiomyopathy Diagnosis
jacc.org/doi/10.1016/j.jacca…
Evaluation of the Elusive Delta Wave in Intermittent Pre-excitation
jacc.org/doi/10.1016/j.jacca…
An Abrupt Doubling of Heart Rate
jacc.org/doi/10.1016/j.jacca…
Junctional Ectopic Tachycardia After Adult Cardiac Surgery
jacc.org/doi/10.1016/j.jacca…
Three Voices of the Atrium: A Unique Case Finding on a Neonate ECG
jacc.org/doi/10.1016/j.jacca…
Repolarization Abnormalities — T-Wave, QT and J-Wave
Wellens’ Sign and Syndrome Detected With the Home Use of a Novel 12-Lead Electrocardiogram
jacc.org/doi/10.1016/j.jacca…
Macroscopic T-Wave Alternans in QTc Prolongation: A Warning Sign Before Torsades de Pointes
jacc.org/doi/10.1016/j.jacca…
Short QT Syndrome Masquerading as Lone Atrial Fibrillation: Hidden in Plain Sight
jacc.org/doi/10.1016/j.jacca…
A Reversible ECG Signature of Hypothermia
jacc.org/doi/10.1016/j.jacca…
QRS Axis, Localization and Artifact
Posteroseptal RVOT PVCs in a Clockwise-Rotated Congenital Heart: A Left-Sided Illusion
jacc.org/doi/10.1016/j.jacca…
Northwest Axis on Electrocardiogram: Decoding an Unusual Cardiac Axis in a Young Patient
jacc.org/doi/10.1016/j.jacca…
Crochetage Sign on Electrocardiography as a Diagnostic Marker of Patent Foramen Ovale
jacc.org/doi/10.1016/j.jacca…
An Electrocardiographic Artifact Mimicking Pacemaker Malfunction
jacc.org/doi/10.1016/j.jacca…
This ECG Does Not Fit: Rethinking Left Ventricular Hypertrophy
jacc.org/doi/10.1016/j.jacca…
Pseudo-Infarction Reversal in Right Precordial Leads: ECG Evolution in Severe Pulmonary Hypertension
jacc.org/doi/10.1016/j.jacca…
@aroniskn
@CraigBasman
@JACabreraCardio
@MiChen__
@aabha_divya
@sarano_maurice
@MarcEngels7
@Miho_Fukui_
@CardioOncCO
@Nishaki1
@MMarinCuartas
@ChrissyMD2000f
@ACHDocTMoe
@PanjrathG
@jsaef1
@Kentso987
@m_taramasso
@SyedZaidMD
Author’s Handles:
@mariaelisasales
@BPushparaji
@MattSegar
@sudarshanballa
@sthangjui
@aronismd
@luisreneps
@DrAvinash_
@dlypourlis
@dr__hunt
@JustinMarkMD
@jennyjlcao
@abhishek_mbbs
@MayoClinicC
@MayoCVFellows
@mazenkawji
@stavrosstavrak1
@drdave0
@AishKamble67
@RobertHelmMD
@YooTaeKyung1
@albcipri6
@LauraDemichiel
Arihant Jain, MD retweeted
Welcome to our JULY 29 issue of #JACCCaseReports @JACCJournals featuring Part 2 of the EKG Challenge
jacc.org/journal/case-report….
Full PDF here:
jacc.org/doi/10.1016/S2666-0…
Thank you @aroniskn our Associate Editor for this Editor’s Page:
Clues, Not Patterns: The Electrocardiogram as a Detective Story
jacc.org/doi/10.1016/j.jacca…
@minnowwalsh
@hmkyale
@Justine_Turco
Wide-Complex Tachycardia: VT and VT Mimics
Wide-Complex Tachycardia in a Neonate
jacc.org/doi/10.1016/j.jacca…
Atypical Andersen–Tawil Syndrome in an Asymptomatic Child With Bidirectional Ventricular Tachycardia and Incipient Tachycardiomyopathy
jacc.org/doi/10.1016/j.jacca…
An Extreme Wide-Complex Tachycardia and Tremors
jacc.org/doi/10.1016/j.jacca…
Seamless Transition Between Narrow- and Wide-QRS Tachycardia Revealing Double Tachycardia
jacc.org/doi/10.1016/j.jacca…
AVNRT With Intermittent Aberrancy-Mimicking Ventricular Tachycardia: One Tachycardia, Two QRS Morphologies
jacc.org/doi/10.1016/j.jacca…
Atrial Tachycardia and Bundle Branch Re-Entry Ventricular Tachycardia with Similar QRS Complex Morphology
jacc.org/doi/10.1016/j.jacca…
Irregularly Irregular Wide Complex Tachycardia: Look Beyond the Atrium
jacc.org/doi/10.1016/j.jacca…
Ventricular Tachycardia or Not?: Decoding Post-Cardioversion Wide Complex Tachycardia in a CRT-D Patient
jacc.org/doi/10.1016/j.jacca…
Device Interrogation Unmasking Flecainide-Induced Wide Complex Tachycardia
jacc.org/doi/10.1016/j.jacca…
Wide QRS Tachycardias With Syncope: Two for One?
jacc.org/doi/10.1016/j.jacca…
ST-Segment Deviation Patterns and STEMI Mimics
Takotsubo Cardiomyopathy With Dynamic LVOT Obstruction Mimicking Inferior STEMI
jacc.org/doi/10.1016/j.jacca…
Atrial Repolarization as a Rare Mimicker of ST-Segment Elevation Myocardial Infarction: Revisiting Ta
jacc.org/doi/10.1016/j.jacca…
Reading the ECG in Time: Ta-Wave Pseudo-STEMI and Crochetage Sign in Adult Congenital Heart Disease
jacc.org/doi/10.1016/j.jacca…
Shark-Fin Pattern in aVR Lead as First Manifestation of Acute Left Main Coronary Artery Occlusion
jacc.org/doi/10.1016/j.jacca…
“Left Main” Pattern Electrocardiogram: A Diagnostic Trap for Cardiologists
jacc.org/doi/10.1016/j.jacca…
Isolated Cardiac Rhabdomyoma With Marked ST-Segment Elevation: Benign Tumor, Malignant ECG
jacc.org/doi/10.1016/j.jacca…
Midventricular Hypertrophic Cardiomyopathy With Apical Aneurysm Presenting as Persistent ST-Segment Elevation Mimicking Acute Myocardial Infarction
jacc.org/doi/10.1016/j.jacca…
ST-Segment Elevation Caused by Lung Cancer Mimicking STEMI
jacc.org/doi/10.1016/j.jacca…
ST-Segment Elevation in a Patient With Vocal Cord Cancer: A Great Mimicker
jacc.org/doi/10.1016/j.jacca…
A Dangerous Wave: Recognizing the Shark-Fin ECG Sign in STEMI
jacc.org/doi/10.1016/j.jacca…
Atrioventricular Block and Conduction
A Premature Ventricular Complex as Both Culprit and Cure: Paroxysmal Intrinsic Atrioventricular Block
jacc.org/doi/10.1016/j.jacca…
Progressive Conduction Disease in a Mitochondrial Disorder
jacc.org/doi/10.1016/j.jacca…
From Ophthalmoplegia to Multilevel Atrioventricular Block: Timing Cardiac Device Therapy in Kearns–Sayre Syndrome
jacc.org/doi/10.1016/j.jacca…
Syncope and 2:1 Atrioventricular Block in a Middle-Aged Man
jacc.org/doi/10.1016/j.jacca…
Idiopathic 2:1 AV Block With Ventriculophasic Sinus Arrhythmia in a Young Male
jacc.org/doi/10.1016/j.jacca…
Mobitz Type I Progressing to High-Grade AV Block: Beyond Wenckebach
jacc.org/doi/10.1016/j.jacca…
Intermittent Simultaneous Antegrade Dual Nodal Conduction With Progressive Rate-Dependent Aberrancy
jacc.org/doi/10.1016/j.jacca…
Dual Atrioventricular Nodal Physiology in Sinus Rhythm: An Extraordinary Manifestation of a Common Substrate
jacc.org/doi/10.1016/j.jacca…
The Double Fire Phenomenon With Alternating Right Bundle Aberrancy
jacc.org/doi/10.1016/j.jacca…
Atrial Activation and the PR Interval: Pre-excitation and Impulse-Origin Puzzles
The Many ECG Faces of Wolff-Parkinson-White Syndrome
jacc.org/doi/10.1016/j.jacca…
Left Ventricular Hypertrophy With Pre-Excitation: Thinking Beyond the Usual Hypertrophic Cardiomyopathy Diagnosis
jacc.org/doi/10.1016/j.jacca…
Evaluation of the Elusive Delta Wave in Intermittent Pre-excitation
jacc.org/doi/10.1016/j.jacca…
An Abrupt Doubling of Heart Rate
jacc.org/doi/10.1016/j.jacca…
Junctional Ectopic Tachycardia After Adult Cardiac Surgery
jacc.org/doi/10.1016/j.jacca…
Three Voices of the Atrium: A Unique Case Finding on a Neonate ECG
jacc.org/doi/10.1016/j.jacca…
Repolarization Abnormalities — T-Wave, QT and J-Wave
Wellens’ Sign and Syndrome Detected With the Home Use of a Novel 12-Lead Electrocardiogram
jacc.org/doi/10.1016/j.jacca…
Macroscopic T-Wave Alternans in QTc Prolongation: A Warning Sign Before Torsades de Pointes
jacc.org/doi/10.1016/j.jacca…
Short QT Syndrome Masquerading as Lone Atrial Fibrillation: Hidden in Plain Sight
jacc.org/doi/10.1016/j.jacca…
A Reversible ECG Signature of Hypothermia
jacc.org/doi/10.1016/j.jacca…
QRS Axis, Localization and Artifact
Posteroseptal RVOT PVCs in a Clockwise-Rotated Congenital Heart: A Left-Sided Illusion
jacc.org/doi/10.1016/j.jacca…
Northwest Axis on Electrocardiogram: Decoding an Unusual Cardiac Axis in a Young Patient
jacc.org/doi/10.1016/j.jacca…
Crochetage Sign on Electrocardiography as a Diagnostic Marker of Patent Foramen Ovale
jacc.org/doi/10.1016/j.jacca…
An Electrocardiographic Artifact Mimicking Pacemaker Malfunction
jacc.org/doi/10.1016/j.jacca…
This ECG Does Not Fit: Rethinking Left Ventricular Hypertrophy
jacc.org/doi/10.1016/j.jacca…
Pseudo-Infarction Reversal in Right Precordial Leads: ECG Evolution in Severe Pulmonary Hypertension
jacc.org/doi/10.1016/j.jacca…
@aroniskn
@CraigBasman
@JACabreraCardio
@MiChen__
@aabha_divya
@sarano_maurice
@MarcEngels7
@Miho_Fukui_
@CardioOncCO
@Nishaki1
@MMarinCuartas
@ChrissyMD2000f
@ACHDocTMoe
@PanjrathG
@jsaef1
@Kentso987
@m_taramasso
@SyedZaidMD
Author’s Handles:
@mariaelisasales
@BPushparaji
@MattSegar
@sudarshanballa
@sthangjui
@aronismd
@luisreneps
@DrAvinash_
@dlypourlis
@dr__hunt
@JustinMarkMD
@jennyjlcao
@abhishek_mbbs
@MayoClinicC
@MayoCVFellows
@mazenkawji
@stavrosstavrak1
@drdave0
@AishKamble67
@RobertHelmMD
@YooTaeKyung1
@albcipri6
@LauraDemichiel
A technically perfect intubation can still end badly. Not because of what happened before the tube. Because of what happened after.The overlooked 30 minutes following intubation may be more important than we think.
📖 Read: The Forgotten 30 Minutes
lifeonthefrontline.com/p/the…
🔄 Repost if you've ever seen a patient deteriorate after a "successful" airway.







