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 →
Author Archive for: srrezaie
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 →
Background: Aspirin is the most widely used antiplatelet agent in acute coronary syndromes. The bulk of the evidence for this came from the second international study of infarct survival (ISIS-2) published in the Lancet in 1988. Read more →
Background: Nitroglycerin is a first line agent in the treatment of ACS. The physiologic basis for it’s use rests on it’s ability to promote coronary vasodilation resulting in increased blood flow to the coronary arteries . Nitroglycerin, is typically given as sublingual tablets or sublingual spray of 0.3 – 0.4mg q5min x3 for ischemic chest pain and only after this is IV NTG given for persistent pain. Read more →
Background: The first report for supplemental oxygen for angina was in 1900, and since then oxygen therapy has been a commonly used treatment of patients with ST-Elevation Myocardial Infarction (STEMI). The reason for this is the belief that supplemental oxygen will increase oxygen delivery to ischemic myocardium and help reduce myocardial injury. This belief is based off lab studies and older clinical trials, but there have been other studies that suggest potential adverse physiologic effects of supplemental oxygen in acute coronary syndromes (ACS) (i.e reduced coronary blood flow, increased coronary vascular resistance, and production of reactive oxygen species) causing vasoconstriction and reperfusion injury. Read more →