The advent of percutaneous coronary intervention (PCI) led to a decrease in morbidity and in-hospital mortality for patients presenting with ST-elevation myocardial infarctions (STEMI). In 1999 the American College of Cardiology and American Heart Association updated their guidelines with the benchmark door-to-balloon time (DTB) to be less than 90 minutes. It has since been adopted as a measure of quality with many hospitals attempting to achieve faster times with the thought that shorter times will improve clinical outcomes.
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Journal Review
Risks of Aggressive Reduction of Door-to-Balloon Time
Journal Review
Identification of High-Risk ACS Patients Using POC Echo
Current American Heart Association (AHA) recommendations suggest that high-risk patients with unstable angina or NSTEMI should undergo early invasive intervention. Risk stratifying these patients generally relies on serial EKGs and troponins, which can delay findings and subsequent intervention as these tests require time and do not have optimal sensitivity or specificity.
Though not a traditional part of the Emergency Department (ED) workup,
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Journal Review
Idarucizumab for Reversal of Dabigatran
Dabigatran Site of Action (www.medscape.com)
The burdens associated with the use of traditional anticoagulants such as subcutaneous heparins and oral vitamin K antagonists (VKAs) have spurred the popularity of non-vitamin K oral anticoagulants (NOACs) for stroke prevention in patients with nonvalvular atrial fibrillation and for the prevention and treatment of venous thromboembolism.
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Journal Review
Treatment of Acute, Non-Traumatic Low Back Pain
Acute, non-traumatic low back pain (LBP) is a common chief complaint and has been estimated to lead to more than 2.7 million ED visits annually nationwide. It affects a broad range of individuals and can be painful and debilitating long after an initial ED visit. Often times in clinical practice, evidence based decisions on medical management of acute lower back pain seem to be thrown out the window;
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Journal Review
Prophylactic Antibiotics in Fingertip Amputations
Fingertip amputations are common. Treatment options range from healing by secondary intention to flap coverage or replantation. Selection of the appropriate treatment modality depends on the nature of the injury, the physical demands of the patient, and the patient’s co-morbidities. Prophylactic antibiotic use in patients with fingertip amputations is controversial. The routine use of prophylactic antibiotics is universally recommended on grossly contaminated wounds,
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Core
Vertebral Osteomyelitis
Vertebral osteomyelitis is a rare disorder characterized by inflammation of the vertebrae. Recognition can be difficult + delayed.
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Journal Review
Lactate in Critically Ill Patients with UGIB
Within the Emergency Department (ED), rapid identification and stabilization of critically ill patients with upper gastrointestinal bleeding (UGIB) is essential to patient survival. While there are some clinical prediction scores, ED physicians most often depend on clinical gestalt when risk stratifying and managing these patients. The most commonly used scores are the Glasgow-Blatchford score, AIMS65 and the Rockall score.
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