May 27, 2019

Background: In 2000, the U.S. achieved the elimination of measles, defined as the absence of sustained transmission of the virus for more than 12 months [3,7]. Unfortunately, this success was short lived.  According to the CDC, 555 cases of measles have already been confirmed from Jan 1st – April 11th, 2019 [3]. This resurgence in measles is frustrating as it has a safe and highly effective vaccine, and it has no animal reservoir to maintain circulation.  Failure to get vaccinated unfortunately stems from misconceptions about vaccine safety (i.e. the now-debunked claim connecting vaccination to autism [4,5]), poor health education, lack of access to health care, and complacency.  This is now a global epidemic as disease does not respect borders.

May 23, 2019

Background: The clinical importance of immediate coronary angiography, with subsequent percutaneous coronary intervention (PCI) in OHCA patients without STEMI is a matter of debate.  We have already covered the COACT trial on REBEL EM, but this is a second study, the pilot phase of the DISCO trial, assessing immediate vs delayed coronary angiography in patients with OHCA and without STEMI on ECG.

May 23, 2019

Background: Predicting a challenging airway is important to assist in the most optimal approach to airway management during RSI.  Two such tools include the Mallampati and LEMON scores and were derived in the pre-operative setting. Major limitations of these scores include the requirement of patients to be awake and cooperative and they don’t incorporate physiologic factors into them. The HEAVEN criteria is a recently developed tool thought to be more relevant and feasible for emergency airway assessment.  Each letter of HEAVEN stands for the difficult airway characteristic:
  • Hypoxemia - ≤93% at the time of initial laryngoscopy
  • Extremes of size – Pediatric patient ≤8 years of age or clinical obesity
  • Anatomic challenge – any structural abnormality that is anticipated to limit laryngoscopic view
  • Vomit/blood/fluid – Clinically significant fluid noted in the pharynx or hypopharynx prior to laryngoscopy
  • Exsanguination – Suspected anemia raising concerns about limiting safe apnea times
  • Neck mobility issues – Limited cervical range of motion

May 20, 2019

Background: Atrial fibrillation (AF) is a common cardiac dysrhythmia encountered in the emergency department (ED), affecting 2.7 million - 6.1 million Americans annually. Hospitalizations with AF as the primary diagnosis total >467,000 annually. AF is associated with a 5-fold increased risk of ischemic stroke, a 3-fold increase in risk of heart failure, and a 2-fold increased risk of mortality. (1) Previous RCTs comparing outcomes of rhythm-control using antiarrhythmics with rate-control in patients with AF failed to show a benefit of rhythm control on mortality. (2,3) However, for some patients, rhythm control improves symptoms and is associated with a better quality of life. (4) Given that up to 70% of AF terminates spontaneously within 24 hours, can we adopt a delayed, or wait-and-see (WAS), approach to AF in the ED and avoid early cardioversion? (5).

May 16, 2019

Essentials of Emergency Medicine 2019 is taking place at the Cosmopolitan Hotel/Casino in Las Vegas, NV. I was asked to give five lectures on varying topics and wanted to share what was discussed at each of these sessions.  If you haven't been to Essentials of Emergency Medicine, you need to add this conference to your list of conferences to attend.  The organizers pride themselves in discussing the latest practice-changing research and have meticulously designed content to maximize enjoyment and retention. In my humble opinion this conference is the quintessential medutainment extravaganza that applies learning theory principles, with amazing speakers, to provide you with the latest and greatest for clinical practice.