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practice updates

BNP Level in the Emergency Department: Does it Change Management?

BNP (Brain Natriuretic Peptide) is a commonly used biomarker for detecting heart failure in the emergency department. It's levels can be affected by various extraneous factors such as obesity and renal failure. This article reviews the potential uses of BNP, including its pros and cons, in the emergency department.

practice updates

Updates on TIA

The transient ischemic attack (TIA) places patients at high risk for future stroke. This article reviews the current literature on the diagnosis, management and disposition of patients with TIA. The use of observation and TIA clinics is also discussed.

practice updates

Identifying Complete Heart Block and the use of Temporary Cardiac Pacing in the Emergency Department

Third degree, or complete, heart block indicates complete dissociation between the atria and the ventricles. It is a cardiac emergency that has numerous causes including primary cardiac, electrolyte and medication toxicity. It needs to be managed with emergent pacing, either trancutaneous or transvenous. This article describes complete heart block and its management.

practice updates

I’ve got a pulse… now what? – Post-Arrest Care in the Acute Setting

“I’ve got a pulse,” you hear the nurse shout. Finally, a sigh of relief comes over the crowded resuscitation room and you take a moment to reflect on what just happened... but, your work is just now about to truly begin. It is up to you to determine why the patient died in the first place and determine which crucial steps need to be initiated to increase your patient’s chance of survival.

practice updates

Left Bundle Branch Block in Myocardial Infarction: An Update

Editor's note: This article was listed in the LITFL Review 154's "Best of #FOAMed" section.

The left bundle branch arises from the Bundle of His, and subsequently is divided into the anterior and posterior fascicles. The anterior fascicle is usually supplied by septal perforators from the Left Anterior Descending artery, and the posterior fascicle typically has a dual supply from septal perforators from the Left Anterior Descending artery and the Posterior Descending artery (arising from the Right Coronary). Electrocardiographically, a LBBB is defined as QRS duration greater than or equal to 120 ms; a broad-notched or slurred R wave in leads I, aVL, V5, and V6; absent Q waves in leads I, V5, and V6; and an R peak time >60 ms in leads V5 and V6 but normal in leads V1 to V3 (1). LBBB can be transient and/or rate-related (1). These morphologic changes make it difficult to discern whether or not a patient presenting to the emergency department with chest pain is experiencing a STEMI. [...]