11 Oct 2018

October 11, 2018

Written by REBEL EM
Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of high-risk disease compared to standard physiologic testing.  However, many published trials on CCTA were not adequately powered to evaluate patient oriented end points.  The aim of the current published study was to perform a systematic review and meta-analysis comparing CCTA with other standard of care (SOC) approaches in evaluation of patients with acute chest pain.
Medical Categories: Cardiovascular
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11 Oct 2018

October 11, 2018

Written by REBEL EM
Background: CCTA has become a popular modality in the ED setting to assess anatomic atherosclerotic disease in patients presenting with chest pain.  Advocates of CCTA feel that CCTA has a greater accuracy in identifying obstructive coronary artery disease and identification of high-risk disease compared to standard physiologic testing.  However, many published trials on CCTA were not adequately powered to evaluate patient oriented end points.  The aim of the current published study was to perform a systematic review and meta-analysis comparing CCTA with other standard of care (SOC) approaches in evaluation of patients with acute chest pain.
Medical Categories: Cardiovascular
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4 Oct 2018

October 4, 2018

Written by REBEL EM
Background: Currently, several medications are recommended for the management of atrial fibrillation with rapid ventricular response in the emergency department including calcium channel blockers, beta blockers and digoxin (the optimal choice is still up for debate). Magnesium sulfate may play a role as a supplemental medication based on its ability to decrease the frequency of sinus node depolarization, prolongation of the refractory period of the atrioventricular node, and acting as a calcium antagonist inhibiting calcium currents in cardiomyocytes.  In addition,panerai radiomir replica intravenous magnesium is safe and cheap.  Most previous trials on the use of magnesium sulfate have rather small sample sizes or were performed in post-cardiac surgery patients.  Also, the exact dose of magnesium used in previous studies varied significantly making it difficult to determine which dose would be the most optimal in these patients.  Recently, the LOMAGHI study was just published trying to answer the questions behind many of these issues.
Medical Categories: Cardiovascular
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2 Oct 2018

October 2, 2018

Written by REBEL EM
I was asked to give a talk at ACEP 2018 on Building the Perfect Curriculum and given 25 minutes to make this happen.  As you can imagine there is no way the entirety of building a perfect curriculum can be done in 25 minutes nor is there such a thing as the perfect curriculum, as we are always evaluating and modifying our current curriculum. Therefore the perfect curriculum can always get better.  For the sake of this talk however, there are essentially 3 steps to building the perfect curriculum: A needs assessment, optimizing the learning, and evaluation of the curriculum.  I opted to focus on optimizing learning.  Every year it seems this talk focuses on Kerns 6 step approach to curriculum development, (which is simply one of many models out there) but there is no emphasis on what to do during lectures and weekly conferences.
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2 Oct 2018

October 2, 2018

Written by REBEL EM
Background: For the 1st time we have 4 generations in the workplace.  The reasons for this include, people are living longer on one end of the scale and there has been a huge acceleration in speed of information leading to quicker development of younger generations.  The remainder of this post will serve to describe a generational survival guide by explaining the reasons why each generation has the qualities that summarize why each generation is the way it is.
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