Sudden cardiac arrest has very poor outcomes; less than 11% of patients in cardiac arrest in the Emergency Department survive to discharge from the hospital. The management of cardiac arrest is algorithmic because providers have limited tools at their disposal and limited knowledge of the patient’s past medical history. EKG is limited in its evaluation of cardiac function.
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Journal Review
Transesophageal Echo in Cardiac Arrest
Core
Aortic Dissection
Aortic dissection is a true medical emergency where time to diagnosis and treatment greatly effects morbidity and mortality.
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Journal Review
D-dimer in Aortic Dissection
Acute Aortic Dissection (AD) is an uncommon, but potentially fatal cardiovascular disorder with a mortality of 1-2% per hour. This requires rapid identification and diagnosis, however, there are a limited number of screening tools available. Currently three diagnostic studies are employed: CT, MRI and TEE. Unfortunately, these modalities are time consuming, carry the risk of radiation and contrast reactions (in the case of CT) and are not always accessible (i.e.
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Journal Review
Revisiting the “Golden Hour” of Trauma
“The Golden Hour”, a widely accepted concept that transport of the trauma patient within the initial 60 minutes after injury purports better outcomes has little empiric evidence directly supporting this relationship between time and outcome. While there have been many studies that suggest a survival benefit to shorter on-scene time and shorter transit time; most studies fail to substantiate a relationship.
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Journal Review
ATLS: Archaic Trauma Life Support?
ATLS teaches inexperienced providers a systemic approach to trauma, with focus on stabilization and appropriate transfer of care. It is designed for providers who do not have much trauma exposure, not necessarily for providers who work in major trauma centers. This article reviews the scope of ATLS training and asks whether it is important or relevant for providers in major trauma centers.
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Journal Review
Recurrent Visits for Kids with Serious Bacterial Infections
Sepsis and meningitis are rare but feared diagnoses in children, especially when they are unable to provide any meaningful history. Based upon available evidence, it can be assumed that delayed diagnosis in a dangerous condition would lead to worse outcomes. Children under the age of one month are almost universally treated as if they are immunosuppressed for this reason,
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Journal Review
Oral Steroids for Acute Lumbar Radiculopathy
Acute lumbar radiculopathy is characterized by radiating buttock and leg pain in a lumbar nerve root distribution caused by herniation of the nucleus pulposus. It has a lifetime prevalance greater than 10% and can result in significant pain and disability. Epidural steroid injections and lumbar diskectomy are commonly performed, however oral steroids may provide the same anti-inflammatory benefits are less invasive,
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Journal Review
ESCAPE Trial – Endovascular Therapy in Ischemic CVA
Over the past decade, endovascular therapy has been increasingly studied as a potential intervention for ischemic stroke. However, prior randomized trials of endovascular therapy in ischemic stroke failed to demonstrate clinical benefit. The prevailing thought from those studies was that patients most likely to benefit from endovascular therapy were not carefully selected. Specifically, patients did not receive rapid imaging to demonstrate a proximal occlusion and to rule out a large area of infarction prior to inclusion in those studies.
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