Cardiac Cath Following Cardiac Arrest in Patients Without STEMI

Journal Club Podcast #7: October 2013

This month, the outspoken Chandra Aubin and hold hands and talk about which patients should undergo urgent cardiac cath following cardiac arrest...

Bottom Line: 

In patients with ST-elevation myocardial infarction (STEMI) on ECG following ROSC, the International Liaison Committee on Resuscitation (ILCOR) clearly recommends that reperfusion therapy be attempted.  In patients without STEMI, ILCOR is less clear, though, and recommends only that one “consider immediate coronary angiography in all post-cardiac arrest patients in whom ACS is suspected.”

Posted on November 11, 2013 and filed under Cardiology, Resuscitation, Critical Care.

Outpatient Management of Acute PE

Journal Club Podcast #6

This month, Chris Carpenter and I chat about the safety and feasibility of managing acute pulmonary embolism in the outpatient setting...

Bottom Line: 

According to Rosen’s textbook of emergency medicine, approximately 1 in every 500 to 1000 (0.1%-0.2%) ED patients have a pulmonary embolism (PE).  Autopsy data ranges from 0.07% (Silverstein 1998) to 0.2% (Anderson 1991, Hansson 1997), although experts believe that clinical estimates of PE incidence underestimate the true value as opposed to autopsy, which often overestimates the true incidence (White 2003)... 

Posted on October 7, 2013 .

Clinical Decision Rules in Low-Risk Chest Pain

Journal Club Podcast  #5

Chief resident Tim Koboldt sits down with me to talk about low-risk chest pain, knowledge translation, and breaking down barriers...  

Bottom Line: 

Chest pain remains a common chief complaint among patients presenting to the Emergency Department, accounting for more than 10 million visits annually in the US. According to data from the Physician Insurers Association of America, more than a quarter of all money paid in closed malpractice claims from 1985 to 2003 involved patients with a chief complaint of “chest pain.” Given the high risk of malpractice, and increased morbidity...

Posted on August 29, 2013 and filed under Cardiology.

Intranasal Naloxone in Acute Opiate Overdose

Journal Club Podcast #4

Emergency Physician and Toxicologist  Evan Schwarz sits down with me to discuss intranasal naloxone administration... 

Bottom Line:  

Opiate overdose remains a significant health problem in the US and elsewhere, with increasing overall rates of overdose and death related to overdose observed.  Naloxone remains the second most commonly administered antidote in the US...

Posted on August 1, 2013 .

Cardiac Ultrasound in Cardiac Arrest

Journal Club Podcast #3

Ultrasound expert Dan Theodoro and I discuss the use of cardiac ultrasound in predicting outcomes in cardiac arrest...

Bottom Line: 

Out-of-hospital cardiac arrest remains a leading mechanism of death in the United States, with an estimated incidence of 300,000 events per year (McNally 2011). Overall survival has remained stable at approximately 8% since the 1950s (Sasson 2010) despite initiatives to improve survival rates (improved bystander CPR, public use of automated external defibrillators...

Posted on July 8, 2013 and filed under Ultrasound, Resuscitation.

The INTERACT2 Trial- Blood Pressure Reduction in Spontaneous Intracerebral Hemorrhage

June 2013 - Article of the Month Podcast #2

Anderson CS, et al. Rapid Blood-Pressure Lowering in Patients with Acute Intracerebral Hemorrhage. N  Engl J Med. 2013 June 20.

Context: 

Patients with hemorrhagic stroke, or intracerebral hemorrhage (ICH), are common in emergency medicine and frequently present to the emergency department with significantly elevated blood pressures requiring urgent treatment. The correct goal blood pressure is debatable. On one hand... 

Posted on June 24, 2013 and filed under Neurology, Neurosurgery.

Asymptomatic Hypertension in the Emergency Department

Journal Club Podcast #2

My good friend Greg Polites and I sit down and discuss the evaluation and management of patients with asymptomatic severely elevated hypertension in the emergency department...

Bottom Line: 

Elevated blood pressure remains a common finding in patients presenting to the emergency department (Karras 2005). While the detrimental effects of long-standing untreated hypertension have been well-documented with respect to the risk of stroke, myocardial infarction, and chronic kidney disease, the risks of untreated hypertension in the short-term... 

Posted on June 12, 2013 and filed under Cardiology.