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 change by removing this recommendation. Several papers have recently been published discussing a modified Sgarbossa’s criteria and a new algorithm to help decrease false cath lab activation and/or fibrinolytic therapy but, are they ready for primetime? Read more →
62 year old male with chief complaint of weakness. Patient had a complicated hospital course including necrotizing fasciitis which required surgical debridement and IV antibiotics. Patient was discharged home with oral antibiotics and returned to the ED with a chief complaint of weakness, abdominal pain, and 3 weeks of loose bowel movements.
BP: 100/51 HR 93 RR 16 Temp 97.2 O2 Sat 98% on RA
ECG from triage is shown… Read more →
Differentiating between SVT with aberrancy versus VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to come up with a simple criteria to help differentiate between the two with high sensitivity and specificity. Read more →
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 this the best evidence we have? Is there nothing more recent? Well, it turns out there is.
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 risk of Azithromycin with cardiovascular death and received lots of press. Read more →