30 Sep 2020

September 30, 2020

Written by REBEL Cast, REBEL Core
Take Home Points
  • 100k people in US have sickle cell, the majority will at some point develop acute chest syndrome (ACS)
  • The mortality rate per episode is 3-9%, similar to those of STEMI
  • ACS is a syndrome - CXR infiltrate + respiratory symptoms
  • Treat it aggressively and early (antibiotics, respiratory support)
  • If you’re considering exchange transfusion - get hematology onboard quickly
Medical Categories: Cardiovascular, Hematology and Oncology
2 Likes
9 Jul 2020

July 9, 2020

Written by REBEL EM
Background: Acute atrial fibrillation (AF) is one of the most common dysrhythmias seen in the emergency department (ED). There has been extensive discussion and debate about the best way to manage acute AF centered around rate and rhythm control.  However, there is little data to guide the optimal approach to rhythm control once this option is selected. As a result of the absence of good evidence, there is significant variation in management. Better data is integral to establishing best practices. The RAFF2 randomized trial attempted to provide more data on this debate of electrical vs pharmacological cardioversion in patients with acute atrial fibrillation/flutter.
Medical Categories: Cardiovascular
3 Likes
2 Jul 2020

July 2, 2020

Written by REBEL EM
Background: In patients presenting to the ED with acute coronary syndrome (ACS), dual antiplatelet therapy is the current standard treatment.  This typically consists of aspirin and an adenosine diphosphate receptor antagonist.  It is fairly well understood that prasugrel and ticagrelor provide greater, and more rapid platelet inhibition than clopidogrel (i.e. Plavix) [5][6]. Both ticagrelor and prasurgel have a class I recommendation for use in ACS with or without ST-segment elevation. The loading strategies of these two medications are different: ticagrelor is administered as a pre-treatment medication prior to diagnostic angiography while prasugrel is given after coronary anatomy has been assessed by angiography (No advantage has been observed when prasugrel is used as pretreatment) [7].  The authors of this trial (ISAR-REACT 5) looked to compare ticagrelor vs prasugrel in patients with ACS to evaluate efficacy and safety.
Medical Categories: Cardiovascular
1 Like
6 May 2020

May 6, 2020

Written by REBEL Covid-19, REBEL EM
There continues to be a slew of publications coming out on a near daily basis in regard to COVID-19.  Some publications will deserve their own posts and others can really be summarized in one or two paragraphs.  In this post I will summarize 5 papers published in the past week, that I found interesting and each has a unique, but important message.  None of these papers are very long, but there are some important aspects of each I felt tied into each other from a cardiovascular standpoint.
Medical Categories: Cardiovascular, Infectious Disease
2 Likes
27 Apr 2020

April 27, 2020

Written by REBEL EM
Background: In patients with stable coronary artery disease the goals of treatment are to reduce the risk of death, ischemic events, and to improve quality of life. In order to achieve those objectives all patients with coronary artery disease should be treated with guideline based medical therapy. Currently, many of them undergo elective angiography and placement of stents if needed when they have abnormal stress tests. Before the widespread use of drug-eluting stents, trials evaluating incremental effects of revascularization added to medical therapy did not show a reduction in the rates of death or MI. However, those trials did not include sufficient numbers of participants, and only included those with known coronary anatomy prior to randomization.
Medical Categories: Cardiovascular
0 Likes
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