December 2016 REBEL Cast: Obstructive Left Main Coronary Artery Disease

obstructive-left-main-coronary-artery-diseaseThe standard treatment for patients with obstructive left main coronary artery disease has typically been coronary-artery bypass grafting (CABG), however some newer trials have suggested that maybe drug-eluting stents may be an acceptable alternative to CABG in select patients. In this episode we will be reviewing the two most recent publications on this topic:

  1. The EXCEL Trial
  2. The NOBLE Trial

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Cardiac Arrest, Return of Spontaneous Circulation (ROSC) With No ST-Segment Elevation on ECG. Now What?

cardiac-arrestBackground: The American Heart Association/American College of Cardiology (AHA/ACC) give a Class I recommendation for activation of the cardiac catheterization lab in patients with out-of-hospital cardiac arrest (OHCA) whom ST-segment elevation myocardial infarction (STEMI) is present.  The evidence for early cardiac catheterization in patients after cardiac arrest, with ROSC and no STEMI is a bit more controversial.  The most recent 2015 AHA/ACC guidelines recommend, “it may be reasonable,” to perform an emergent cardiac catheterization in select patients without STEMI. Continue reading

The CACTUS Trial: Anticoagulation for Symptomatic Calf Deep Vein Thrombosis?

cactus-trialBackground: The optimal management of isolated calf deep vein thrombosis (DVT) is not completely clear, based on the available evidence. The authors of this paper state up to 50% of all lower extremity DVTs are infra-popliteal. Because there is not a lot of robust evidence to guide us on the best diagnostic and therapeutic treatments, a huge variation in practice is seen. To help try and answer these questions the authors of this paper performed the Compression versus Anticoagulant treatment and compression in symptomatic Calf Thrombosis diagnosed by UltraSound – CACTUS Trial. Continue reading

The REASON Trial: POCUS in Cardiac Arrest

the-reason-trialBackground: For many emergency providers, POCUS has become a critical modality in the resuscitation of patients with cardiac arrest. The authors of this paper (The REASON Trial) state that <8% of all OHCA’s survive to hospital discharge; a dismal number.  We already know that shockable rhythms, early defibrillation, early bystander CPR, and ROSC in the field are all associated with increased survival. What we don’t have is large scale evidence that the use of POCUS improves survival with good neurologic outcomes. Continue reading

IV Lidocaine for Renal Colic: Another Opioid Sparing Option?

renal-colicBackground : For anyone who has taken care of a patient with renal colic, the agony they experience is indelible.  I have had several female patients even tell me that the pain is worse than child birth.  Treatment of renal colic comes down to two key components: treatment of pain and expediting passage of the stone.  Many medications have been tested for the former, and we have discussed the latter on our blog before (HERE and HERE). We had a recent resident journal club discussing a trial comparing IV lidocaine (1.5mg/kg) vs IV morphine (0.1mg/kg) for treatment of pain. Continue reading