MIA 2012: Canto JG et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012 Feb 22;307(8):813-22.

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Chest pain free MI is a very real phenomenon and it is associated with higher mortality – especially in younger women (NRMI study).

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Cardiovascular|

MIA 2012: Campagna JD, et al. The use of cephalosporins in penicillin-allergic patients: a literature review. J Emerg Med. 2012 May;42(5):612-20

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For patients with penicillin (PCN) allergies, it is safe to administer third- and fourth-generation cephalosporins (CPN) with no fear of cross reaction.
Use of first- and second-generation CPN should only be avoided when the penicillin antibiotic shares structurally similar R1 side chains.

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Tox & Medications|

MIA 2012: Nishijima DK et al. Immediate and delayed traumatic intracranial hemorrhage in patients with head trauma and preinjury warfarin or clopidogrel use. Ann Emerg Med. 2012 Jun;59(6):460-8.e1-7.

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CREST study: Patients presenting to the emergency room with blunt head trauma and preinjury warfarin or clopidogrel use have a high incidence of immediate intracranial hemorrhage, but a very low incidence delayed intracranial hemorrhage. Thus, if the initial head CT is negative, you should be able to discharge the patient home…

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Tox & Medications, Trauma|

MIA 2012: Hoffmann U et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012 Jul 26;367(4):299-308.

Bottom Line ¹

ROMICAT-II study: Coronary CT angiography (CCTA) is a safe and faster diagnostic strategy than the standard evaluation of low-to-intermediate risk chest pain patients. CCTA, however, results in higher radiation exposure and more downstream testing.

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By Michelle Lin, MD|2016-11-11T18:38:52-08:00Jan 1, 2013|Cardiovascular|

MIA 2012: Backes D, et al. Time-dependent test characteristics of head computed tomography in patients suspected of nontraumatic subarachnoid hemorrhage. Stroke. 2012 Aug;43(8):2115-9

Bottom Line ¹

100% sensitive and specific if < 6 hours from headache onset
90% sensitive if after 6 hours

A noncontrast head CT can effectively rule out atraumatic subarachnoid hemorrhage (aSAH) in patients who present with acute headache within six hours after ictus. Those who present outside this time window or present atypically for SAH (ie neck pain) require further workup, including a lumbar puncture.

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Neurology, Radiology|

MIA 2012: Samuels-Kalow ME et al. Effective discharge communication in the emergency department. Ann Emerg Med. 2012 Aug;60(2):152-9

Bottom Line ¹

This study tells us what we might already suspect: in the busy, hectic and loud Emergency Department, patients we discharge often lack comprehension of their hospital course. Additionally, they are frequently unable to report their diagnosis, a discharge plan or reasons they should return to the ED.

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By Michelle Lin, MD|2016-11-11T18:37:29-08:00Jan 1, 2013|Medical Education|

MIA 2012: Pearce MS et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012 Aug 4;380(9840):499-505.

Bottom Line ¹

Interpret this data how you will: Exposure to 2-3 CT scans of the head will triple the risk of brain tumors; 5-10 head CT scans will triple the risk of leukemia. In absolute terms, this translates into approximately 1 excess case of leukemia and 1 excess brain tumor per 10,000 patients.

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By Michelle Lin, MD|2016-11-11T18:42:23-08:00Jan 1, 2013|Pediatrics, Radiology|

About Michelle Lin, MD

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