Let’s start off with a case: 29 year old male, HR: 140, BP: 70/40, Temperature of 39.1. Sounds like straight forward, bread-and-butter emergency medicine doesn’t it? That is, until you look at the past medical history: Single Ventricle Hypoplastic RV Left AV Valve Atresia Large Ventricular Septal Defect Patent FormalRead More →
Chest pain is a common presenting complaint to Emergency Departments (ED) worldwide. Massive resource investment is required to differentiate benign from sinister causes of chest pain, and for the treatment, referral, and risk stratification of chest pain patients. A cardiac etiology of chest pain is found in roughly 15% ofRead More →
Methodology Score: 3/5 Usefulness Score: 3/5 Nazerian P, et al. Circulation. 2018 Jan 16;137(3):250-258. Editorial – Biomarker-Assisted Diagnosis of Acute Aortic Dissection. Question: The ADvISED trial was an International Multicenter prospective observational study of a novel diagnostic strategy that integrated the Aortic Dissection Detection Risk Score (ADD-RS) and D-Dimer in an ED population to rule outRead More →
In this post, we will discuss updates and controversies surrounding rate control in Afib, specifically we will: Review the new 2017 CAEP Afib best practices guidelines Review Tachycardia Induced Cardiomyopathy Review Afib and Type 2 ACS Discuss the identification and management of secondary Afib 2017 CAEP AAF Best Practices GuidelineRead More →
Journal Club Summary Methodology: 3.5/5 Usefulness: 3/5 Peacock WF, et al. JAMA Cardiol. 2017 Dec 13 EDITORIAL: The Wait for High-Sensitivity Troponin Is Over-Proceed Cautiously Korley FK. JAMA Cardiol. 2017 Dec 13 Question and Methods: This prospective, observational, multicenter study evaluated if a negative hsTnt assay at 0h and 3h post EDRead More →
Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 3.5/5 Cournoyer A, et al. Acad Emerg Med. 2017 Sep;24(9):1100-1109. Question and Methods: Retrospective observational cohort study to evaluate if the addition ACLS to BLS during EMS management for Out-of-Hospital cardiac arrest – OHCA (and for a predefined subgroup of potential ECMO candidates) improve ratesRead More →
Journal Club Summary Dewey M, et al. BMJ. 2016 Oct 24;355:i5441. Methodology: 2.5/5 Usefulness: 2.5/5 Question and Methods: Prospective single center RCT to determine whether patients with intermediate probability of CAD and atypical chest pain/angina should undergo cardiac CT or coronary angiography. Findings: The study found no difference in major procedural complications withinRead More →
Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 3.5/5 Question and Methods: This meta-analysis included prospective studies to assess the ability of a single negative hs-cTnT and non-ischemic ECG to identify patients at low risk for AMI. Findings: The results of 11 studies were pooled, resulting in a pooled sensitivityRead More →
There are a few specific arrhythmias that we encounter often in the ED that deserve a little bit more thought. Dr. Matthew Lipinski takes us through a few updates in the area beyond the routine basics. For other Grand Rounds Summaries please see our archives. Chronic Bundle Branch Block andRead More →
Journal Club Summary Hofmann R, et al. N Engl J Med. 2017 Sep 28;377(13):1240-1249. Methodology Score: 4/5 Usefulness Score: 4/5 Question and Methods: This large, registry-based RCT evaluated the effect of oxygen on patient-centered clinical outcomes for normoxic MI patients. Findings: There were no differences at 365 days or 30Read More →