In patients who present to the Emergency Department (ED) with chest pain whose initial evaluation does not reveal acute myocardial infarction, the American Heart Association (AHA) recommends non-invasive testing to provoke ischemia or to detect coronary artery disease (CAD) before or within 72 hours of their discharge. Such testing is believed to identify patients who might benefit from more invasive therapy,
Read More
Long-term oral beta-blocker use decreases mortality after myocardial infarction (MI). Our guidelines recommend initiation of this within 24 hours of acute MI. The benefit of IV beta-blockade is less clear. It is also unknown whether earlier beta blocker administration is better than delayed administration (within 24 hours).
-COMMIT Trial (2005): Early use of IV metoprolol in AMI decreases incidence of ventricular arryhthmias and reinfarctions,
Read More
Abdominal CT is the most common initial imaging test ordered for suspected nephrolithiasis in the Emergency Department. This is largely due to its high sensitivity for the diagnosis of kidney stones and ability to assess for other high-risk diagnosis. However, CT scan results in exposure to ionizing radiation with related long-term cancer risk and a high rate of incidental findings.
Read More
Acute dyspnea is a common Emergency Department complaint; in 2003 this chief complaint comprised about 3.5% of more than 115 million emergency department visits nationwide. A subset of these patients will present in respiratory distress, which is associated with increased morbidity and mortality. Often it can be hard to determine the exact etiology of the shortness of breath in a timely fashion,
Read More
Background: Anaphylaxis is a condition that represents the best of Emergency Medicine: rapid onset of life-threatening symptoms that can be reversed with expeditious interventions. It is defined as the presence of any of the following:
Read More
Bronchiolitis is the leading cause of hospitalizations among infants in the United States. Hospitalizations for this disease have increased and it has been hypothesized that reliance on oximetry values may be at least partly responsible for the increase. There is no absolute consensus on whether supplemental oxygen is required in patients with saturations between 90-95%.
Read More
Injury is the leading cause of death in the United States in the 1 to 44 year old age group and the 3rd leading cause of death overall. In patients reaching the hospital with trauma, massive hemorrhage is a major cause of mortality. Damage control resuscitation (DCR) is a concept first put forward by the US Department of Defense in 2004 but has been widely adopted for civilian trauma as well.
Read More
Sudden cardiac arrest is common and, obviously, very bad. In the US, there are about 500,000 cardiac arrests each year. About half of these cardiac arrests are out of hospital cardiac arrest (OHCA) and the survival rate is pretty poor. The most recent survival estimates put it at 7 – 9.5% in most communities.
Read More