The Pulse - December 2025

Greetings Readers! In this monthly edition, we examine 2 practice changing studies.

Are you uncertain which RSI agent is safer: etomidate and ketamine?

Studies exploring this intervention and more were covered this month in Premium Pulse. For less than a cup of coffee each month, get access.

1. Rusting Dogma: IV Iron as an Adjunct Therapy in Acute Bacterial Illness

   In this large retrospective, propensity-matched analysis of hospitalized adults with iron deficiency anemia and acute bacterial infections, administration of IV iron during active infection was consistently associated with lower short- and long-term mortality across multiple infection types, including MRSA bacteremia, pneumonia, UTIs, colitis, and cellulitis. Mortality reductions were substantial at both 14 and 90 days, accompanied by greater hemoglobin recovery and reduced transfusion requirements, without clinically meaningful increases in length of stay or need for mechanical ventilation. These findings challenge the longstanding concern that IV iron exacerbates infection by increasing pathogen access to iron. The absence of benefit in meningitis likely reflects limited sample size rather than a true lack of effect. Collectively, the data support reconsideration of IV iron as a safe and potentially beneficial adjunct in selected hospitalized patients with active infection and iron deficiency anemia, pending prospective validation. Sohail et al. Blood 2025 Nov.

   Study Type: retrospective, propensity-matched cohort study of hospitalized patients with iron deficiency anemia and MRSA bacteremia (15,022), pneumonia (27,062), UTI (23,114), colitis (7,938), cellulitis (13,005), and meningitis (143).

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2. eSCAPE Artists: High-Dose Nitroglycerin Clears the Lungs More Quickly

   In this single-center retrospective study of 441 ED patients with sympathetic crashing acute pulmonary edema (SCAPE), initiating IV nitroglycerin (NTG) at a high dose (≥100 μg/min) led to faster liberation from supplemental oxygen compared with lower starting doses. High-dose NTG achieved more rapid blood pressure control without increasing hypotension, intubation rates, vasopressor use, or ICU admissions. Despite presenting sicker, high-dose patients had a shorter ICU length of stay and an unadjusted signal toward lower mortality, though confounding limits firm conclusions. Taken together, when SCAPE crashes the party, hitting hypertension hard and early with higher-dose NTG may help patients breathe easier—and sooner—without added downside. Henry K et al. Am J Emerg Med 2025 Dec.

   Study Type: retrospective, single-center cohort study of 441 patients who received IV nitroglycerin for acute pulmonary edema in the ED. Patients were stratified based on initial IV NTG dosing where low-dose group was considered <100 ug/min (n=248) and high-dose group was considered ≥100 ug/min (n=193).

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