Author Archive for: srrezaie

Door to Furosemide (D2F) in Acute CHF…Really?

27 Nov
November 27, 2017

Background: Acute congestive heart failure (AHF) is a common complaint seen in the ED and associated with a high morbidity, mortality, cost, and resources.  Many patients with AHF, ultimately end up being admitted and interventions in the ED can make a huge difference in the outcomes of these patients.  The REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational study with the primary goal of evaluating the door to furosemide time in the treatment of AHF and clinical outcomes. Read more →

It’s Time for Tranexamic Acid (TXA) in Massive Hemorrhage

20 Nov
November 20, 2017

Background: Bleeding from massive hemorrhage in trauma and post-partum are a major cause of death worldwide. There have been two large randomized controlled trials, in trauma and post-partum hemorrhage that have shown administration of TXA within 3 hrs of bleeding onset reduces death due to bleeding. The current meta-analysis that we are going to review sought to quantify the effect of treatment delay in acute severe bleeding by analyzing individual patient-level data from the two randomized clinical trials mentioned above. Read more →

REBEL Cast Episode 42: Research From the Past Year – In the Pipeline

13 Nov
November 13, 2017

Welcome back to Episode 42 of REBEL Cast. In this episode, we will be discussing some studies from the past year that had some interesting results and a couple of papers that are potentially going to change our practice in the near future (In the Pipeline). Again, this 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice. Read more →

Clinical Pearls from ACEP 2017 – Washington D.C.

09 Nov
November 9, 2017

This year ACEP 2017 took place in Washington D.C. from Oct. 29th – Nov 1st, 2017.   There were lots of amazing speakers and topics as was evidenced by the eruption of everyone’s twitter feeds with the #ACEP17 hashtag.  I was fortunate enough to attend this amazing conference and approached by several attendees if I would put together a list of my favorite pearls from this conference.  I decided to put a top 10 list together, in no particular order. Read more →

The Critical Pulmonary Embolism Patient

06 Nov
November 6, 2017

Background: Previously, I had given a talk on the use of thrombolytics in submassive PE in 2016. This year, I had the privilege of speaking at ACOEP 2017 again with an update on the critical pulmonary embolism patient. This post will serve as a reference for that talk.

There are many ways to classify pulmonary embolism, but the best clinical definition would depend on the hemodynamic consequences.  For example, massive pulmonary embolism can be defined as systemic hypotension (SBP < 90 mmHg or a drop in SBP of at least 40mmHg for at least 15 min) or shock (tissue hypoperfusion, hypoxia, altered mental status, oliguria, or cool clammy extremities.)  There is a second subset of patients that also warrant discussion; submassive pulmonary embolism.  These patients are defined as lack of systemic hypotension (<90mmHg), but have right ventricular dysfunction/hypokinesis. RV dysfunction tells us that there is severe pulmonary artery obstruction and impending hemodynamic failure. Read more →

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