Author Archive for: srrezaie

Should we stop prescribing Azithromycin in the ED?

19 Nov
November 19, 2013

azithromycinIn 2011, Azithromycin was the 7th most prescribed (55.3 million prescriptions) medication according to IMS Health.  There have been several publications indicating that the use of macrolide antibiotics, increase risk of serious ventricular arrhythmias and sudden cardiac death (FDA Adverse Event Reporting System). Specifically, 2 recent studies in the NEJM were published looking at the risk of Azithromycin with cardiovascular death and received lots of press. Read more →

R.E.B.E.L. ECG of the Week #3

18 Nov
November 18, 2013

R.E.B.E.L. EM ECG of the Week #3The subject of this ECG of the Week is a 47 y/o hispanic female with a past medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia, and morbid obesity with a chief complaint of weakness.  Per the patient she cleans houses for a living and for the past 2 weeks she gets weak and short of breath earlier in the day while cleaning houses.  She used to be able to clean all day without issues, but for the past 2 weeks this has been getting less and less.  No chest pain, vomiting, diaphoresis, or syncope.  She has never had anything like this before.  She comes to the ER today because this is her only day off.  She has not had any symptoms today.

BP 156/94  HR 68 RR 14 O2 sat 100% on RA   Temp 98.7

ECG from triage is shown…

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R.E.B.E.L. ECG of the Week #2

11 Nov
November 11, 2013

R.E.B.E.L. EM ECG of the Week #258 year old female with chief complaint of chest pain x2hours with PMH of type 2 diabetes mellitus, Hyperlipidemia, and hypertension.    She is brought in via EMS still having active chest pain.

BP: 102/88  HR: 82  RR: 24  O2 Sat on 2L: 99%  Temp 99.0

ECG obtained at arrival is shown…

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R.E.B.E.L. ECG of the Week #1

08 Nov
November 8, 2013

R.E.B.E.L. EM ECG of the Week #168 year old hispanic female with a chief complaint of weakness/syncope.  PMH of type 2 diabetes mellitus and hypertension.  She was brought in via EMS due to the family calling 911 as she had an episode of syncope while at the dinner table.  At the time of arrival:

VS: 96/48   43     18     99% on RA  98.7

ECG obtained at arrival is shown…

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CPR: Hands-on or Hands-off Defibrillation

01 Nov
November 1, 2013

CPRPauses in chest compressions are known to be detrimental to survival in cardiac arrest, so much so that the 2010 American Heart Association (AHA) emphasize high-quality compressions while minimizing interruptions. There have been some studies that now advocate for continuous chest compressions during a defibrillation shock. There have been substantial changes to external defibrillation technology  including:

  • Biphasic shocks with real-time impedance monitoring to reduce peak voltages
  • Paddles being replaced by adhesive pre-gelled electrodes
  • Enhancement in ECG filtering permitting rhythm monitoring during chest compressions.

So the mantra of “hard and fast” may be true when it comes to CPR, but the real question now becomes, should we be continuing CPR during defibrillation?

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