December 18, 2019

Take Home Points

  • Important as front line providers to know research and data behind stroke care
  • Patients eligible for endovascular care are those with large vessel occlusion in the anterior circulation - anterior cerebral artery, middle cerebral artery, distal intracranial carotid artery and they have to have perfusion mismatch (small infarcted core with a large penumbra).
 

November 27, 2019

Take Home Points   
  • End stage liver disease patients have fragile baseline physiology. Minor insults can have profound effects
  • Always start with the basics - large bore IV lines
  • SBP give 3rd generation cephalosporin + albumin in severe disease
  • Upper GI bleed give appropriate blood products + ceftriaxone
 

October 31, 2019

Take Home Points  
  • Stress cardiomyopathy looks like ACS/STEMI, with patient presenting with chest pain, dyspnea or maybe syncope. It looks like ACS and should be treated as such until you prove to yourself it’s not.
  • Classic patient is an older woman with chest pain or syncope after a stressful event.
  • Bedside echo will show left ventricular dysfunction with one of a variety of patterns of wall motion abnormality. The most common is apical, but there are also variant patterns including mid-ventricular, basal, focal and global.
  • Watch for QTc prolongation as this could precipitate an arrhythmia. Be sure to stop all QT prolonging meds and replete magnesium
  • Consider the differential in the patient who has cardiogenic shock because the treatment differs. Avoid catecholamines and if you need inotropic support use dobutamine or dopamine. Look for evidence of left ventricular outflow tract (LVOT) obstruction, as this should be treated like a hypertrophic cardiomyopathy with beta blockers rather than inotropes.