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Door to Furosemide (D2F) in Acute CHF…Really?

Background: Acute congestive heart failure (AHF) is a common complaint seen in the ED and associated with a high morbidity, mortality, cost, and resources.  Many patients with AHF, ultimately end up being admitted and interventions in the ED can make ...

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Cardiovascular

It’s Time for Tranexamic Acid (TXA) in Massive Hemorrhage

Background: Bleeding from massive hemorrhage in trauma and post-partum are a major cause of death worldwide. There have been two large randomized controlled trials, in trauma and post-partum hemorrhage that have shown administration of TXA within 3 hrs of bleeding ...

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Trauma

Spontaneous Bacterial Peritonitis

Definition: Acute infection of the ascitic fluid in a patient with liver disease without another source of infection Epidemiology: (Runyon 1988, Runyon 1988, Borzio 2001) Incidence 10-25% risk of at least one episode per year 20% risk in those with ascites ...

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Infectious Disease

REBEL Cast Episode 42: Research From the Past Year – In the Pipeline

Welcome back to Episode 42 of REBEL Cast. In this episode, we will be discussing some studies from the past year that had some interesting results and a couple of papers that are potentially going to change our practice in ...

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Clinical Pearls from ACEP 2017 – Washington D.C.

This year ACEP 2017 took place in Washington D.C. from Oct. 29th – Nov 1st, 2017.   There were lots of amazing speakers and topics as was evidenced by the eruption of everyone’s twitter feeds with the #ACEP17 hashtag.  I was ...

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CardiovascularOrthopedicsResuscitation

The Critical Pulmonary Embolism Patient

Background: Previously, I had given a talk on the use of thrombolytics in submassive PE in 2016. This year, I had the privilege of speaking at ACOEP 2017 again with an update on the critical pulmonary embolism patient. This post ...

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Thoracic and Respiratory

The Death of MONA in ACS: Part IV – Aspirin

Background: Aspirin is the most widely used antiplatelet agent in acute coronary syndromes.  The bulk of the evidence for this came from the second international study of infarct survival (ISIS-2) published in the Lancet in 1988.

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Cardiovascular

The Death of MONA in ACS: Part III – Nitroglycerin

Background: Nitroglycerin is a first line agent in the treatment of ACS. The physiologic basis for it’s use rests on it’s ability to promote coronary vasodilation resulting in increased blood flow to the coronary arteries . Nitroglycerin, is typically given ...

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Cardiovascular

The Death of MONA in ACS: Part II – Oxygen

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 ...

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Cardiovascular

The Death of MONA in ACS: Part I – Morphine

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 ...

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Cardiovascular
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