August 12, 2019

Background:  In patients with ICH, antiplatelet therapy is withheld due to the perceived risk of hematoma expansion.  Often, these medications are either not restarted or there is prolonged delays until they are restarted, but the risk of occlusive vascular events might be higher without resumption of antithrombotic therapy. A meta-analysis of observational studies found no difference in the risk of hemorrhagic events and a lower risk of occlusive vascular events associated with antiplatelet therapy resumption after any type of intracranial hemorrhage (ICH); however, randomized trials for antiplatelet efficacy in occlusive vascular disease have excluded patients with a history of intracerebral hemorrhage. Due to the paucity of evidence, no guidelines have strong recommendations about long-term anti-platelet therapy after ICH. The RESTART Trial [1] aimed to address the question of whether or not to start antiplatelet therapy following an intracerebral hemorrhagic stroke.

August 8, 2019

Background: Trauma patients can be a rather difficult patient population to treat with multiple ongoing issues.  There is always a balance of hemorrhage control vs prophylaxis for venous thromboembolism (VTE), as both can cause increased morbidity and mortality.  One method to balance this challenging issue is retrievable inferior vena cava (IVC) filters, which at face value sound like a nice solution (Prevent VTE while avoiding worsening hemorrhage).  The main issue with IVC filters is there is limited high quality data to support the use of these devices and IVC filters are not without their own long-term complications as well. Finally, there are also conflicting recommendations depending on which guidelines you choose to read [3][4][5].

August 5, 2019

Background: Epinephrine (adrenaline) remains a central part of management of OHCA in ACLS guidelines. Recent studies (i.e. PARAMEDIC-2) have raised concerns about the efficacy and possible deleterious effects of epinephrine on both overall survival and long-term neurological outcomes. Other observational trials have suggested that there may be a time dependent effect of epinephrine on survival, with earlier timing of epinephrine improving outcomes, and later timing of epinephrine causing deleterious effects[2]. This trial attempts to analyze the association between timing and dose of epinephrine given on survival and neurologic outcomes of patients with OHCA.

July 29, 2019

This is a special edition REBEL Cast done by my good friend Andy Little, DO (Twitter: @andylittle).  As I was busy running the 2nd annual Rebellion in EM clinical conference, Andy was able to sit down with the speakers to summarize their main take away messages from each of their talks.  This post is a summary of day 3.
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