Join Drs. Lauren Rosenfeld and Dr. Arman Hussain cut through the confusion surrounding high sensitivity troponin (hs-Tn) in the Emergency Department. They break down what this cardiac injury marker actually measures, why the new assays allow for faster ACS screening (often in 1–2 hours) at the cost of more "false positives," and the practical application of 0/1h and 0/2h algorithms. They also dive into key pitfalls, including why cutoffs vary between hospitals, how to approach special populations like those with CKD.

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This production is done in partnership with Urgent Matters. Since 2002 Urgent matters has served as a premier dissemination vehicle for strategies on emergency department patient flow and quality.If you want to work with us to produce an episode or have any suggestions please reach out at gwemblog@gmail.com or aloganathan@mfa.gwu.edu.And finally to stay up to date on this podcast and our related efforts subscribe to our newsletter at https://urgentmatters.smhs.gwu.edu/.

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1. Stark M, Sharma S. Troponin. PubMed. Published 2023. https://www.ncbi.nlm.nih.gov/books/NBK507805/
2. Patibandla S, Alsayouri K. Cardiac enzymes. PubMed. Published November 17, 2023. https://www.ncbi.nlm.nih.gov/books/NBK545216/
3. Ming-yu Anthony Chuang, Gnanamanickam E, Karnon J, et al. Cost effectiveness of a 1-hour high-sensitivity troponin-T protocol: An analysis of the RAPID-TnT trial. IJC Heart & Vasculature. 2022;38:100933-100933. doi:https://doi.org/10.1016/j.ijcha.2021.100933
4. Information NC for B, Pike USNL of M 8600 R, MD B, Usa 20894. BUDGET IMPACT ANALYSIS. Canadian Agency for Drugs and Technologies in Health; 2013. https://www.ncbi.nlm.nih.gov/books/NBK168944/
5. Huggins C, Saltarelli N, Swoboda TK, et al. Kinetic changes in high-sensitivity cardiac troponin for risk stratification of emergency department chest pain patients. The American Journal of Emergency Medicine. 2025;93:176-181. doi:https://doi.org/10.1016/j.ajem.2025.04.010
6. Raber I, McCarthy CP, Januzzi JL. A Test in Context: Interpretation of High-Sensitivity Cardiac Troponin Assays in Different Clinical Settings. Journal of the American College of Cardiology. 2021;77(10):1357-1367. doi:https://doi.org/10.1016/j.jacc.2021.01.011
7. McEvoy JW, Tang O, Wang D, et al. Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in U.S. Adults. Journal of the American College of Cardiology. 2023;81(20):2028-2039. doi:https://doi.org/10.1016/j.jacc.2023.03.403
8. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal. 2023;44(38). doi:https://doi.org/10.1093/eurheartj/ehad191
9. Kuster N, Monnier K, Baptista G, et al. Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly. Clinical chemistry and laboratory medicine. 2015;53(5). doi:https://doi.org/10.1515/cclm-2014-0121
10. Boeddinghaus J, Nestelberger T, Twerenbold R, et al. Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardial infarction. European Heart Journal. 2018;39(42):3780-3794. doi:https://doi.org/10.1093/eurheartj/ehy514
11. Kraus D, von Jeinsen B, Tzikas S, et al. Cardiac Troponins for the Diagnosis of Acute Myocardial Infarction in Chronic Kidney Disease. Journal of the American Heart Association. 2018;7(19). doi:https://doi.org/10.1161/jaha.117.008032

Mel's back at it from the past with then intern Hashem covering the common anticoagulants we encounter in the ED and reversal agents, along with a failed attempt by Arman to talk about leeches. If you have any questions/comments/requests/feedback, please email gwemblog@gmail.com.

Hosts: Drs. Melanie Schroeder, Hashem Hraky, Arman Hussain

Content: Melanie Schroeder

Production: Arman Hussain *** This podcast is not endorsed by or sponsored by the George Washington University School of Medicine and Health Sciences, George Washington University Hospital or any other affiliate. All opinions expressed are those of the individuals and not of their employer or affiliated training institutions. The information provided here is for educational purposes only and is not intended to provide any medical advice.

Captain Blackwell takes us through everything you ever wanted to know about Wolff-Parkinson-White syndrome and LGL (I'm not even going to try since it might not even be real). If you have any questions/comments/requests/feedback, please email gwemblog@gmail.com. Show Notes/Resources/References:

Stat pearls chapter on WPW - https://www.ncbi.nlm.nih.gov/books/NBK554437/

Life in the Fast Lane on LGL -

https://litfl.com/lown-ganong-levine-syndrome/

Hosts: Drs. Taylor Blackwell and Arman Hussain

Content: Taylor Blackwell

Production: Arman Hussain *** This podcast is not endorsed by or sponsored by the George Washington University School of Medicine and Health Sciences, George Washington University Hospital or any other affiliate. All opinions expressed are those of the individuals and not of their employer or affiliated training institutions. The information provided here is for educational purposes only and is not intended to provide any medical advice.

Resident Report Dr. Lauren Rosenfeld walks us (Dr. Hashem Hraky and Dr. Arman Hussain) through a late night talk show host's harrowing case of ring avulsion and how to manage it in the ED. If you have any questions/comments/requests/feedback, please email gwemblog@gmail.com. Show Notes/Resources/References: Bamba R, Malhotra G, Bueno RA Jr, Thayer WP, Shack RB. Ring Avulsion Injuries: A Systematic Review. Hand (N Y). 2018 Jan;13(1):15-22. doi: 10.1177/1558944717692094. Epub 2017 Feb 16. PMID: 28720047; PMCID: PMC5755869. Urbaniak JR, Evans JP, Bright DS. Microvascular management of ring avulsion injuries. J Hand Surg Am. 1981 Jan;6(1):25-30. doi: 10.1016/s0363-5023(81)80006-8. PMID: 7204914.

Cleveland Clinic on Ring Avulsion - https://my.clevelandclinic.org/health/diseases/22368-ring-avulsion Jimmy Fallon on Ring Avulsion clip - https://www.youtube.com/watch?v=CztT_pBFQv8&ab_channel=TheTonightShowStarringJimmyFallon

Hosts: Drs. Lauren Rosenfeld, Hashem Hraky, and Arman Hussain

Content: Lauren Rosenfeld

Production: Arman Hussain *** This podcast is not endorsed by or sponsored by the George Washington University School of Medicine and Health Sciences, George Washington University Hospital or any other affiliate. All opinions expressed are those of the individuals and not of their employer or affiliated training institutions. The information provided here is for educational purposes only and is not intended to provide any medical advice.

Resident Report We're moving to more BITE sized episodes! Check out this conversation covering US snake bites with our future tox fellow Dr. Katherine Markin. If you have any questions/comments/requests/feedback, please email gwemblog@gmail.com. Show Notes/Resources/References: ALiEM Snake Bites - https://www.aliem.com/envenomations-snakebites/https://www.aliem.com/envenomations-snakebites/

Journal of Emergency, Trauma, and Shock: Snake Bites - Pearls form the Literature - https://pmc.ncbi.nlm.nih.gov/articles/PMC2700615/

Hosts: Drs. Melanie Schroeder, Katherine Markin, Arman Hussain

Content: Katherine Markin

Production: Melanie Schoeder *** This podcast is not endorsed by or sponsored by the George Washington University School of Medicine and Health Sciences, George Washington University Hospital or any other affiliate. All opinions expressed are those of the individuals and not of their employer or affiliated training institutions. The information provided here is for educational purposes only and is not intended to provide any medical advice.

Chapters:

• (00:00:00) Introduction It's November!
• (00:02:33) Angioedema Risk Stratification with Dr. Feltes
• (00:18:21) AV Blocks with Dr. Blackwell
• (00:45:35) Needle Aspiration of Peritonsillar Abscess with Dr. Hussain
• (01:00:50) Thanks!
• (01:02:20) Get Some Humanity Back - Your Dying Patient's Favorite Song
• (01:04:09) Outro

GW Resident Report It's sweater weather (brr) - we're back this month with a lighter episode of Resident Report podcast! In this episode cover risk stratification of angioedema patients, get back to reading EKGs with a deep dive on AV blocks, talk about how to do a needle drainage of peritonsillar abscess, and lastly Arman suggests something you can do to help learn a little bit about your patients who are unfortunately passing away in the ED. If you have any questions/comments/requests, please email gwemblog@gmail.com.

Show Notes/Resources/References:

1. Predicting airway risk in angioedema: staging system based on presentation⁠
2. The role of fiberoptic nasopharyngoscopy in the management of the acute airway in angioneurotic edema
3. EM:RAP HD Needle Aspiration Procedure Video
4. ALiEM Peritonsillar Abscess Guide
5. Antibiotic vs Drainage in Peritonsillar Abscess Meta-analysis
6. EM:RAP October Introduction

*** This podcast is not endorsed by or sponsored by the George Washington University School of Medicine and Health Sciences, George Washington University Hospital or any other affiliate. All opinions expressed are those of the individuals and not of their employer or affiliated training institutions. The information provided here is for educational purposes only and is not intended to provide any medical advice.