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
Core
C-Spine Injuries + CT Interpretation
An in depth review of devastating injuries of the cervical spine. See the ABCs of of Reading C-Spine CTs post for some basics.
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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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Core
Testicular Torsion
Testicular torsion is a time sensitive, surgical emergency.This post reviews what to look for on presentation of the acutely painful scrotum
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Journal Review
Isopropyl Alcohol in the Treatment of Nausea
Nausea is a common complaint seen in the Emergency Department (ED). Although there are a number of agents available for treatment, the efficacy and safety of these drugs have recently come into question. Metoclopramide is a commonly used antiemetic agent but it carries significant side effects including akathesia and tardive dyskinesia. Ondansetron is another central acting drug that has been shown to be effective in nausea prophylaxis in patients receiving chemotherapy but has a black box warning due to its effect of prolonging the QT interval.
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Core
Open Fractures
Although relatively straightforward, management of open fractures has some minor nuances that are important for EPs to understand.
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Core
Supplemental O2 in COPD Exacerbation
Does supplemental oxygen harm patients with COPD exacerbations? We explore the basis of this dogmatic teaching.
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