October 11, 2018

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.

October 11, 2018

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.

October 4, 2018

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.

August 2, 2018

Background/Introduction: Acute heart failure is a common diagnosis encountered among patients presenting to the Emergency Department with complaints of shortness of breath. The emergency treatment of these patients has traditionally focused on alleviation of their symptoms of breathlessness and anxiety in addition to optimization of hemodynamics and rapid reduction in both preload and afterload. The treatment of associated symptoms has often included the administration of morphine, which has been posited to have both beneficial physiologic (vasodilation, reduction of preload) and central nervous system (reduction of breathlessness, anxiety, and pain) effects. However, recent experimental and experiential data have pointed to morphine’s potential for effecting negative physiological and CNS responses, thereby raising the possibility of increasing patient morbidity and/or mortality. Additionally, no large randomized controlled trials have been conducted to study the potential risks and benefits of morphine administration in patients presenting with acute heart failure. Despite these factors, a contingent of Emergency Physicians continue to routinely use morphine in the treatment of patients presenting with acute heart failure.

July 18, 2018

Have you ever heard an entire lecture on sinus tachycardia? Neither have I. It is the most common cardiac dysrhythmia seen in critically ill adults and kids, but it is the least frequently talked about. Sinus tachycardia may not be the sexiest rhythm and we don't think of cardioverting it or giving some new anti-arrhythmic drug, but it is a sign that something may be seriously wrong. To be fair, it’s not the sinus tachycardia we are really worried about, but rather what’s causing the sinus tachycardia that should be our main concern.
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