Archive for category: Clinical

Three Predictors of Success in Cardiac Arrest

25 Jan
January 25, 2014

The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not taking an ACLS and BLS course and going through the motions of a code. There have been several studies looking at the quality of intubation and CPR, and their association with […]

The HEART Score: A New ED Chest Pain Risk Stratification Score

10 Jan
January 10, 2014

Chest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e. acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis). The challenge in the ED is to not only to identify high risk […]

Modified Sgarbossa Criteria: Ready for Primetime?

03 Dec
December 3, 2013

The recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists.  According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new 2013 STEMI guidelines made a drastic […]

Does a Porcelain Gallbladder Equal Gallbladder Cancer?

21 Nov
November 21, 2013

Gallbladder cancer (GBC) incidence ranges from 12 – 62% when porcelain gallbladder (PGB) is seen.  You ever wonder where these numbers come from?  Well, these are the quoted numbers from two studies done in 1959 and 1966.  These studies also indicated that if porcelain gallbladder was seen, that a prophylactic cholecystectomy should be performed. Is […]

Should we stop prescribing Azithromycin in the ED?

19 Nov
November 19, 2013

In 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 […]

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