I had a patient with perisstent Supraventricular tachycardia (SVT). My approach usually starts with REVERT, and if unsuccessful will continue with Adenosine. Adensoine with its rapid onset, and short half-life regardless…
Another Canadian risk score published in AEM, discussing Short-term Risk of Arrhythmia among Patients With Syncope. This is a multicenter prospective cohort study with 5,010 patients. This study had very good sensitivity: 97%…
Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure is a prospective, multicenter study was done in Japan. The goal of study was to…
This is an interesting review of 8209 patients with PE. 3 most common finding that predict shock in PE patients are: Tachycardia, T wave inversion in V1, and ST elevation…
One of our favorite question in ED is: “Does this patient with chest pain have ACS?” JAMA in Nov. 2015 tried to answer this question from the eyes of cardiologist…
I cannot say that we did not know about this, but having an article to support this is very exciting. Jeff Kline and his colleagues analyzed 45 studies of 8,209…
Troponin 1 set, 2 sets, 3 sets, Stress test, Echo, Observation vs Admission. LOW risk chest pain, when will be a safe practice. JAMA internal medicine in March found patients that they do not have
I was reading an article regarding Managing Afib in Annals of EM. They are recommending Amiodarone 300 mg IV over an hour and then 10-50 mg/hour for 24 hour.
Be careful, when you are trying to rate control your afib/aflutter patient. Using rate or rhythm control in patient with an acute underlying disease,
This is my post in 2012, Annals of Emergency Medicine published a study this month regarding same topics.
Another study from AJR in Jan 2015 focused on dizziness/syncope. Due to difficulty to define definition of dizziness among patients, they used 3 terms of Dizziness, Syncope, and
In adult patients with suspected acute nontraumatic thoracic aortic dissection, is a negative serum D-dimer sufficient to identify a group of patients at very low risk for the diagnosis
We discussed 2 studies in our class specific session on impact of EPi on out of hospital cardiac arrest. J Am Coll Cardiol published another study this month and challenged again use of Epi in OHCA. 1,556 patients from 2000 to 2012, using EPi with different doses, and the conclusion is pre-hospital use of epinephrine was consistently associated with a lower chance of survival.
Morphine can affect functionality of Clopidogrel. There is an article in JACC, March 2014, that showed “Morphine delays clopidogrel absorption, decreases plasma levels of clopidogrel active metabolite, and retards and diminishes its effects,
This is an old study by Annals of EM, The Role of Cardiac Risk Factor Burden in Diagnosing Acute Coronary Syndromes in the Emergency Department Setting, Feb 2007. Of 10,806 eligible patients, 871 (8.1%) had acute
After long wait! for JNC 8, it came online on Dec18, 2013. It was a long journey between JNC 7 and 8, it took 10 years! and now it is not endorsed by NHLBI(National Heart, Lung, Blood Institute).
Acad Emerg Med, Feb 2013 published a Canadian retrospective cohort study reviewed patients with ECG, presented to ED with atrial fibrillation. The Outcome measure was mortality in short and long term (30 , 90 , 365 days) among patients with atrial fibrillation who had different primary ED diagnosis for their visits.
There is a new clinical Policy that Published in Feb, Evaluation and Management of Adult Patients in the Emergency Department With Asymptomatic Elevated Blood Pressure. There was always a big ? regarding triage and disposition of these patients. There is no great data even on this clinical policy but at least we have some references for that. They answered to following questions:
This is the last update in 2012, but I am happy to end this year with one of the most challenging topics in medicine. The article is from J Am Coll Cardiol in Dec. You can find the Full text link here
1. Remeber: Troponin elevation imparts a worse prognosis, irrespective of the underlying etiology.
JACC in 2001 published an article that nicely explained the necessity of interpreting lead aVR in clinical setting. There are 3 categorizes that we should consider in this regard:1. acute…
What does typical chest pain mean? Traditionally, we thought that midsternal chest pain with radiation to left arm and increased with exertion, we just had another discussion on this topic on our grand round and all the studies and even
What is your favorite hypertension numbers to treat in ED? there are a lots of controversies regarding the exact number to start treatment in ED but recent Cochrane review on mild HTN suggest that antihypertensive agents used in the treatment of adults with hypertension stage I (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg)
Annals of Emergency Medicine published an article which it provided a formula to determine if we can differentiate between STEMI vs Early Repolarization. I really do not know in an acute setting I am able to sit down and calculate this but sometimes in terms of training it could be fun to do this practice!!!
I read this article long time ago but I had a discussion with one of my resident and to give her reference I would like to have it here. Basically…
There is a State-of-the-Art Paper in the latest edition of Journal of the American College of Cardiology, May 2012.The title of article is New Concepts in the Assessment of Syncope.…
We always taught that Morphine can decrease preload and can help with anxiety and pain in acute flash pulmonary edema. But evidence does not support this Claim.
American Society of Echocardiography (ASE) and the American College of Emergency Physicians (ACEP) described the important role of focused cardiac ultrasound (FOCUS) in patient
This is one of the challenging topics in EM. when should you stop CPR? what parameters do you have to continue versus terminate CPR?