The patient with acute valvular emergency can be terrifying. These patients may rapidly decompensate, and the physiology and management are complex. What can you do to prepare? This post provides pearls and pitfalls in the evaluation and management of patients with acute valvular emergency. You may be surprised what you read…
Acute Valvular Emergencies: Pearls and Pitfalls Read More »
The HEART score and pathway have revolutionized evaluation of the chest pain patient in the ED. This pathway can reduce risk of missed major cardiovascular event to < 1%. Many centers utilize the HEART pathway; however, do the score and pathway have a weakness?
The Great and Powerful HEART Score: Does it have a weakness? Read More »
Cardiac arrhythmias are not common in pregnancy, but they can occur. While the workup and management is quite similar to the non-pregnant patient, there are subtle differences. This is a brief review of the ED management of unstable and stable tachycardic arrhythmias in pregnancy.
Tachycardic Arrhythmias in Pregnancy: Management Read More »
Heart failure is a common condition managed in the ED. The primary cause of heart failure is related to ischemic heart disease, but many other conditions can lead to heart failure. Patients can present in several ways. This post investigates the ED evaluation and management of patients with different types of heart failure.
ED Management of Heart Failure: Pearls and Pitfalls Read More »
In cardiac arrest care there has been a lot of focus over the years on limiting interruptions in chest compressions during CPR. In fact, this concept has become a major focus of the current AHA Guidelines. Why?
R.E.B.E.L. EM – Beyond ACLS: Pre-Charging the Defibrillator Read More »
Unstable and symptomatic bradycardias require urgent intervention. This is an overview of bradycardias and how to approach them in the emergency department.
An Approach to Bradycardia in the Emergency Department Read More »
Lead aVR is a commonly ignored lead and I have even heard of it referred to as the Rodney Dangerfield of ECG leads as it gets no respect. I have anecdotally heard many EM physicians activate the cath lab for STE in lead aVR and many cardiologists say that these are not STEMI patients. So is lead aVR now getting too much respect? Well, I thought it would be a great idea to bring the great Amal Mattu on to the show to answer a few questions for us regarding STE in lead aVR.
Coronary CTA has risen to the forefront of chest pain evaluation, providing an anatomical evaluation of coronary artery vasculature. When negative, it improves negative predictive value of ACS. Additionally, CCTA allows for a better means to diagnose CAD when compared to history, physical exam, ECG, and biomarkers. But, is CCTA useful to further risk stratify low-risk patients? Who might benefit from CCTA and what are the risks?
Chest Pain Controversies: Coronary CTA Use (Part 2) Read More »
Chest pain accounts for approximately 8-10 million healthcare visits in the U.S. per year and can be associated with a variety of benign to life-threatening diseases. Acute coronary syndrome is one of the major considerations in the ED. Approximately 20% of lawsuits are due to misdiagnosis and mismanagement of ACS and a large percentage of patients are admitted due to this risk. However, few admitted patients go on to be diagnosed with ACS. Although commonly used to help risk stratify patients in the ED, there is no evidence that stress testing decreases risk of future cardiac events. This post will examine chest pain risk stratification in the ED and the utility of stress testing.
Chest Pain Controversies: Risk Stratification and Stress Test Utility (Part 1) Read More »
Chest Pain (CP) is a very common complaint seen in emergency departments around the world. In the US specifically anywhere from 8 – 10 million patients present to the ED complaining of CP. Many use liberal testing strategies to prevent missing acute coronary syndrome (ACS) or other major adverse cardiac events (MACE), but this is not without increase in healthcare cost and false positive testing leading to more downstream testing.
R.E.B.E.L. EM – Management and Disposition of Low Risk Chest Pain Read More »
