About Salim Rezaie, MD

ALiEM Associate Editor Clinical Assistant Professor of EM and IM University of Texas Health Science Center at San Antonio Founder, Editor, Author of R.E.B.E.L. EM and REBEL Reviews

Upper Gastrointestinal Bleeding: Evidence-Based Treatment

Upper Gastrointestinal Hemorrhage: Treatment ControversiesUpper gastrointestinal bleeding remains a common reason for emergency department visits and is a major cause of morbidity, mortality, and medical care costs. Often when these patients arrive, the classic IV-O2-Monitor is initiated and hemodynamic stability is assessed. Some of the next steps often performed include:

  1. Determination of the site and rate of bleeding (upper vs lower)
  2. Initiation of proton pump inhibitors (PPIs)
  3. Somatostatin analogs if variceal bleeding is suspected
  4. Prophylactic antibiotics
  5. Packed red blood cell (PRBC) transfusion for low hemoglobin and hematocrit levels

What is the evidence for these treatments, and do they affect morbidity and mortality?

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2016-12-21T09:15:52-07:00

Trick of the Trade: Fist Bump to Reduce Pathogen Transmission

Fist BumpHandshaking has been practiced as far back as the 5th century BC and used today as a common way of greeting others. In the hospital setting this occurs multiple times throughout the day. Many alternatives to the handshake have been developed and utilized, but they have failed to replace the handshake as a form of greeting. Nosocomial infections have been identified as a major preventable complication of inpatient care and one of the most important initiatives to reduce this is hand hygiene. The authors of this study propose the fist bump as a safe and effective way to avoid hand-to-hand contact and therefore reduce transmission of infection. 1 (more…)

2016-11-11T19:19:34-07:00

Blood Pressure Management in Adults (JNC 8 and ACEP Policy)

Black tonometer and heart isolated on whiteHypertension is one of the most common conditions seen in primary care clinics and emergency departments (EDs).  Frequently, patients are found to have asymptomatic hypertension and referred to EDs for management, despite the fact that rapidly lowering blood pressure is not necessary and may be harmful.  Yet many clinics still refer these patients for emergent management. In December 2013, the Eighth Joint National Committee (JNC 8) published a new, open-access, evidence-based hypertension guideline in JAMA.  They only cited randomized clinical control trials to answer three questions:

  1. Does initiating antihypertensive pharmacologic therapy at specific BP thresholds improve health outcomes?
  2. Does treatment with antihypertensive pharmacologic therapy to a specified BP goal lead to improvements in health outcomes?
  3. Do various antihypertensive drugs or drug classes differ in comparative benefits and harms on specific health outcomes? (more…)
2019-02-19T18:22:49-07:00

Is Pelvic Exam in the Emergency Department Useful?

graves-vag-speculum-lg-30-20-miltexWomen with undifferentiated abdominal pain and/or vaginal bleeding commonly present to the emergency department. Many textbooks advocate for the pelvic exam as an essential part of the history and physical exam. Performance of the pelvic exam is time consuming to the physician and uncomfortable for the patient. It is with great regularity that emergency physicians make clinical decisions, based on information derived from the pelvic examination, but is this information reliable and does it effect the clinical plan of patients?

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2016-11-11T19:18:21-07:00

Should We Admit All Patients with Sternal Fractures?

Sternum-FractureThe detection rate of sternal fractures following motor vehicle collisions and blunt trauma to the chest and abdomen has increased over the past decade.  The reason for this increase is most likely from the use of seat belts and better imaging modalities such as computed tomography (CT) in trauma patients. I can recall as a resident being told that any patient with a sternal fracture should be admitted to trauma because of the high likelihood of blunt cardiac injury and high mortality rate associated with this injury, but is this always true?

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2016-11-11T19:18:08-07:00

The HEART Score: A New ED Chest Pain Risk Stratification Score

chest_pain_1600_clr_2153Chest pain is a common presentation complaint to the emergency department (ED) and has a wide range of etiologies including urgent diagnoses (i.e. acute coronary syndrome (ACS), pulmonary embolism, aortic dissection) and non-urgent diagnoses (i.e. musculoskeletal pain, gastroesophageal reflux disease (GERD), pericarditis). The challenge in the ED is to not only to identify high risk patients but also to identify patients who can be safely discharged home. Specifically, when dealing with ACS, dynamic ECG changes or positive cardiac biomarkers is pretty much a slam dunk admission in most cases, but a lack of these does not completely rule out ACS. Currently, most guidelines and risk stratification scores focus on the identification of high risk ACS patients that would benefit from early aggressive therapies, but what about all the other chest pain patients that don’t have ACS… are they accounted for?

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2016-12-16T10:43:34-07:00

Modified Sgarbossa Criteria: Ready for Primetime?

Modified Sgarbossa Criteria TitleThe recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists. According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new 2013 STEMI guidelines made a drastic change by removing this recommendation. Several papers have recently been published discussing a modified Sgarbossa’s criteria and a new algorithm to help decrease false cath lab activation and/or fibrinolytic therapy, but are they ready for primetime? (more…)

2016-11-11T19:17:42-07:00