The Death of MONA in ACS: Part II – Oxygen

05 Nov
November 5, 2017

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 →

The Death of MONA in ACS: Part I – Morphine

05 Nov
November 5, 2017

Background: Morphine is a commonly used medication in acute coronary syndromes (ACS) to help relieve pain which in turn can help reduce sympathetic tone.  Over the past few years however, there has been some concern raised about the drug-drug interactions with antiplatelet agents causing impaired platelet inhibition as well as an association with worsened clinical outcomes.  P2Y12 receptor antagonists (i.e. Clopidogrel, Pasugrel, Ticagrelor) are typically administered with aspirin (dual anti-platelet therapy) as one of the cornerstones of treatment for ACS.  This drug-to-drug interaction can cause delayed inhibition of platelet activation and potentially worsen clinical outcomes. Read more →

Acetaminophen vs. Diclofenac vs. Combo for Acute MSK Pain

02 Nov
November 2, 2017

Background: Acute, minor musculoskeletal injuries (i.e. non-fracture or dislocations) are frequently seen in the Emergency Department. Aside from ruling out a more severe injury, management often focuses on pain relief or mitigation of pain. Though many analgesic agents exist, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for this indication. Both have important side effects or potential for adverse events that must be considered when prescribing them. Finally, it is unclear if combining the two classes of medications is beneficial. Read more →

NSTEMIs Are Not All the Same

30 Oct
October 30, 2017

Background: Acute coronary syndrome (ACS) is a true spectrum of disease: STEMI, NSTEMI, Unstable Angina (UA), and Stable Angina (SA).  The history and physical plus ECG help us to differentiate patients with STEMI from NSTEMI.  Classically, STEMI represents complete occlusion of a culprit artery and this finding requires immediate coronary angiography and revascularization.  It turns out that there is a subset of NSTEMI patients that also have complete total occlusion (TO) of culprit arteries despite not having true ST elevation on ECG, which unfortunately causes delays in definitive treatment. Read more →

REBEL Cast Episode 41: Research From the Past Year – Resuscitation

26 Oct
October 26, 2017

Welcome back to Episode 41 of REBEL Cast. In this episode, we will be discussing some studies from the past year that caught our attention in the area of resuscitation. Again, this 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice. Read more →

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