EM Quick Hits 67 Tick Borne Illness Update, Pediatric ECG Interpretation, Nailbed Repair, Closed Loop Communication, ESRD, Leaders in EM Dr. Catherine Varner

Topics in this EM Quick Hits podcast

Isaac Bogoch on tick borne illness update - anaplasmosis and babesiosis (1:30)

Matthew McArther on evidence-based update in nailbed repair (9:32)

Kathleen Stephanos on simplified approach to pedatric ECG interpretation (19:05)

Shawn Segeren on closed loop communication done right (30:36)

Brit Long on basic approach to end stage renal disease (36:02)

Catherine Varner & Victoria Myers on leadership and career choices in EM (44:08)



Podcast production, editing and sound design by Anton Helman

Podcast content, written summary & blog post by Anton Helman, August, 2025

Cite this podcast as: Helman, A. Bogoch, I. McArther, M. Stephanos, K. Segeren, S. Long, B. Myers, V. Varner, C. EM Quick Hits 67 - Tick Borne Illness Update, Pediatric ECG Interpretation, Nailbed Repair, Closed Loop Communication, ESRD, Leaders in EM Dr. Catherine Varner. Emergency Medicine Cases. August, 2025. https://emergencymedicinecases.com/em-quick-hits-month-year/. Accessed September 14, 2025.

Tick Borne Illnesses Beyond Lyme: Don’t Miss Co-Infections

Why it matters: Warmer, shorter winters are expanding tick ranges; Lyme is rising and under-reported. Same Ixodes ticks can transmit anaplasmosis and babesiosis—co-infection rates up to ~10–20% in highly endemic US regions. Think broadly.

When to test for tick borne illnesses



If you’re ordering Lyme serology, also order anaplasma and babesia testing, especially with non-localizing febrile illness after tick exposure or travel from tick country.

Erythema migrans: treat empirically for Lyme; serology may be negative early. Still send Lyme serology to aid downstream decision-making. Repeat if symptoms persist.



Treatment cues



Anaplasmosis: often covered by your Lyme doxycycline course; clue = fever + leukopenia.

Babesiosis: not covered by doxy; treat like malaria (e.g. atovaquone + azithromycin). Order specific testing.



Bottom line: If you thought “order Lyme,” add anaplasma + babesia—and tailor treatment if babesiosis is in play.

Expand to view reference list



Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical practice guidelines by the IDSA, AAN, and ACR: 2020 guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis. 2021;72(1):e1-e48.

Krause PJ, Auwaerter PG, Bannuru RR, et al. IDSA 2020 guideline on diagnosis and management of babesiosis. Clin Infect Dis. 2021;72(2):e49-e64.

Biggs HM, Behravesh CB, Bradley KK, et al. Diagnosis and management of tick-borne rickettsial diseases: Rickettsia, Ehrlichia, and Anaplasma. MMWR Recomm Rep. 2016;65(2):1-44.

Diuk-Wasser MA, Vannier E, Krause PJ. Coinfection by the tick-borne pathogens Babesia microti and Borrelia burgdorferi: ecological, epidemiological, and clinical consequences. Trends Parasitol. 2016;32(1):30-42.





Nail Bed Injuries: Faster, Simpler—Without Sacrificing Outcomes

Evidence refresh



Skin glue vs sutures: Similar cosmetic/functional outcomes; skin glue is significantly faster.

NINJA Trial (peds) & adult RCT: After standard nail bed repair, discarding the nail is as good as replacing/suturing it.