October 28, 2019

Have you ever wondered how to get your text color to match your image color?  It’s not hard and can make a good slide become an amazing slide.  Matching colors make consistent, professional-looking PowerPoint or Keynote slides.  The steps to make this happen are very simple and in this post, I will hopefully show you how it’s done.  This feature is available from PowerPoint 2013 on, but not on older versions (This can also be done on keynote).

October 24, 2019

Background: Follow-up with a primary care (PC) provider is an important part of healthcare.  Many countries have a robust outpatient system, and the US is no different. However, in the US, there are many challenges to follow up including: appointment availability, insurance status, unclear discharge instructions and socioeconomic status.  Removing some of these barriers by scheduling an appointment before ED discharge could potentially increase outpatient follow up. Use of a simple, low resource bedside intervention that schedules follow-up appointments prior to ED discharge could improve health outcomes and decrease return ED visits.

October 21, 2019

Background Information: Atrial fibrillation is the most commonly encountered dysrhythmia in the emergency department (ED) and is associated with an increased long-term risk of stroke, heart-failure and all-cause mortality.1,2 In fact, the overall mortality rate for patients with atrial fibrillation is approximately double that of patients in normal sinus.3,4 The decision to rate vs. rhythm control patients while in the emergency department remains controversial in the literature and the method of doing so using chemical vs. electrical cardioversion also stirs up debate. Prior studies have shown the success rate of electrical cardioversion alone to be 90%.1,5 other studies have demonstrated that emergency physicians use each strategy roughly half the time.1 The authors of this study sought to determine if one of the two strategies resulted in achievement of normal sinus rhythm and discharge more quickly.

October 17, 2019

Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management.  There are several  vagal techniques in the literature which include, standard valsalva maneuver (sVM), modified Valsalva maneuver (mVM), and carotid sinus massage (CSM). All three techniques aim to increase vagal tone to slow down conduction in the AV node and, hopefully, result in termination of Atrioventricular nodal reentry tachycardia (AVNRT)and atrioventricular reentrant tachycardia (AVRT).  The authors of this trial performed a RCT evaluating the effectiveness of sVM vs mVM vs CSM at not only terminating SVT but also having a sustained effect up to 5 minutes.

October 15, 2019

Background: Evidence from the CRASH-2 trial showed an absolute reduction in mortality of 1.5% (NNT = 67) in patients with extracranial bleeding treated with tranexamic acid  (TXA) within 3 hours of injury. However, CRASH-2 did not answer the question of effect on mortality in patients with intracranial hemorrhage (ICH), as these patients were excluded from the trial.  It makes biologic sense that administration of TXA in patients with traumatic brain injury (TBI) might prevent or reduce ICH expansion and thus avert brain herniation and death.  There were two smaller RCTs [2] that showed a reduction in death with TXA in patients with ICH. However, both of these trials were small and considered to be hypothesis generating only. TICH-2 [3] was an international, randomized, double-blind, placebo-controlled phase 3 trial in adults with ICH from acute stroke with ≈2300 patients and showed no difference between groups in functional status at day 90. TICH-2 did show a small improvement in hematoma expansion at day 2 and death by day 7.  Due to the fact that these  findings were secondary outcomes they were also hypothesis generating. All of the above positive findings therefore required confirmation in a larger randomized trial, which has finally arrived…CRASH-3.