Archive for category: Cardiovascular

The BEST AF Trial: What is the Optimal Energy Selection for Cardioversion in Patients with Afib?

23 Apr
April 23, 2018

Background:There are two trains of thought in using transthoracic direct current cardioversion (DCCV) when it comes to converting atrial fibrillation.  The first is an escalating energy approach which allows cardioversion to occur at the lowest energy for each individual patient and potentially decrease post-shock arrhythmias.  The second train of thought is to start at the […]

(Dis)utility of Orthostatics in Volume Depletion

05 Mar
March 5, 2018

Definition: Orthostatic hypotension (OH) is a form of low blood pressure that occurs with positional change (i.e. sitting up from lying down, standing up from sitting). It is commonly used for the diagnosis of volume depletion Orthostatic Vital Signs A reduction of systolic blood pressure (SBP) of at least 20 mm Hg A reduction in […]

More Trials Showing Harm of Opioids in ACS…or do They?

22 Feb
February 22, 2018

Background: Typical medical treatment of ACS patients include dual antiplatelet therapy (DAPT) and revascularization with primary percutaneous coronary intervention (PPCI).  Nitroglycerin is first line therapy in the treatment of pain in ACS with morphine as a common adjunct. Morphine helps relieve pain which decreases catecholamines and oxygen demand.  We have written about the use of […]

Bacterial Endocarditis

04 Dec
December 4, 2017

Background: Definition Infective Endocarditis (IE) = Inflammation of the endothelium of the heart, heart valves (or both) (Osman 2013) Epidemiology Annual incidence = 5-7 cases per 100,000 (Fraimow 2013) 40,000 to 50,000 new cases in the US per year. Average hospital charges in excess of $120,000 per patient (Bor 2013) Slightly higher male predominance (1.5:1 […]

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 […]