Emergency Medicine Education

Following the release of national guidelines on the management of hypertension in adults, treatment strategies emphasize the use of combination therapy with maximally tolerated doses of first-line agents. These include thiazide diuretics, long-acting dihydropyridine calcium channel blockers such as amlodipine and nifedipine, and either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in nonpregnant adults. Link […]

Very interesting clinical question in patients with atrial fibrillation: should our choice of rate control agent influence bleeding risk in patients receiving DOAC therapy? Emerging data suggest that in patients with atrial fibrillation treated with direct oral anticoagulants such as apixaban or rivaroxaban, concomitant use of diltiazem may be associated with a higher risk of […]

This is a very interesting review addressing a simple yet common clinical question: “Does This Patient Have Volume Overload?” In this narrative review published in JAMA, the authors discuss practical bedside clues from the history, physical examination, and diagnostic testing that help clinicians determine whether a patient is truly volume overloaded. They highlight that while […]

What is the diagnostic accuracy of ECGs in hyperkalemia? Ünlü et al. conducted a study evaluating how well electrocardiogram findings detect hyperkalemia and predict clinical outcomes in the emergency department. Their results showed that ECGs perform poorly as a diagnostic tool for identifying or excluding hyperkalemia. Link to article Link to another article

And the question is: Metoprolol vs. Diltiazem for atrial fibrillation? The more you explore this topic, the more fascinating and nuanced it becomes. When I wrote a chapter on this for Short Stay Management of Atrial Fibrillation, I initially thought we had thoroughly reviewed the evidence. However, during our later systematic review and meta-analysis, we […]

This month we have two important updates from the American Heart Association (AHA). The Circulation journal has released new guidelines for the management of adult hypertension. It is particularly interesting to see how these recommendations differ in defining high blood pressure and related thresholds compared to prior guidelines. Hypertension journal has already put some debates […]

We often tend to spend more time on pediatric resuscitation and CPR compared to adults. However, the question remains: what is the optimal duration of resuscitation efforts in these patients before considering termination? A recent retrospective study from Japan addressed this issue and found that fewer than 1% of children achieved favorable neurological outcomes (defined […]

The overuse of azithromycin during COVID-19 led to several issues, including increased resistance to the medication. Initially, concerns centered around QT prolongation, but a recent retrospective study published in JACC: Advances discusses additional risks associated with azithromycin exposure, including ‘long-term subsequent MI,’ ’30-day hospital readmissions,’ and ’30-day incident heart failure among MI patients.’ Link to […]

The history of publishing hypertension guidelines traces back to the Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The most recent guideline published under the JNC banner was the JNC 7, which was released by the National Heart, Lung, and Blood Institute (NHLBI). The latest JNC 8 was published […]

There is always a debate in the ED that should we send a patient status post ROSC to cath lab or not. JAMA in July 2022 published a French national multicenter study regarding OHCA patient who had a ROSC to assess cerebral performance category. They enrolled 279 patients and they measured 180 days survival rates. […]

Does Anterior-Posterior electrode pad work better than the Anterior-Lateral position? A multicenter Danish study in 468 patients with atrial fibrillation showed the Ant-Lat position was more effective than AP for biphasic cardioversion and converting to sinus rhythm. There was no safety concern between these 2 methods. Link to study

When we published our review “The controversial role of dual sequential defibrillation in shockable cardiac arrest”, our conclusions was further studies are necessary to assess the efficacy and safety of DSD compared to the standard of care treating refractory VF. AEM published another study exactly one year later: Prehospital Double Sequential Defibrillation: A Matched Case-Control […]

JAMA Published a study and proved that intensifying high blood pressure treatment among 4056 patients, before sending the patient home, was not associated with reduced cardiac events or improved BP control, and they will return with adverse events and also will be readmitted. Link to article

Very Useful statement for taking care of patients with chest pain, not shocking news, but interesting to see in cardiology literature, they appreciate our concerns: Acute ischemia was diagnosed in 22% of patients who presented to the ED with sharp or stabbing pain and in 13% of those with pleuritic pain. Seven percent of patients […]

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 of teribble expeince for patient is a great medication, but in this particular patient in 2 occasions was converting SVT to Sinus rhythm and after […]

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% and very poor specificity 53%. Please take a look at the study for 39 different variables that they considered. Link to Abstract

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 observe association between time to Furosemide and clinical outcome among patients visiting ED. 1,291 was registered , 481 patients were in early treatment group. The […]