Rezaie’s Evidence-Based Evidence of the Literature

11 04, 2014

PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism

2016-11-20T07:21:33+00:00

Pulmonary embolism
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Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE.

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3 04, 2014

High Sensitivity Troponin T and Acute Myocardial Infarction: One and Done?

2016-12-20T12:26:50+00:00

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There has been a lot of publicity about evaluation of chest pain patients in the emergency department (ED) with high sensitivity troponin testing. In the past with older troponin assays, clinicians would evaluate patients, get an ECG, and an initial set of cardiac biomarkers. The subsequent set of biomarkers would be performed at 6-8 hours later before determination of disposition. In the past few years, several studies have been published evaluating point of care troponins,  sensitive troponins, and high sensitivity troponins which have changed our practice and evaluation of these patients.  An early version of a study was recently released in the Journal of the American College of Cardiology (JACC) stating that for ED chest pain patients, we may be able to discharge patients from the ED with an initial normal ECG and single high sensitivity troponin T (hs-cTnT). So is it true… one and done?

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12 03, 2014

Upper Gastrointestinal Bleeding: Evidence-Based Treatment

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

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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10 03, 2014

Trick of the Trade: Fist Bump to Reduce Pathogen Transmission

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

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…)

5 02, 2014

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

2016-11-11T19:18:24+00:00

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…)
30 01, 2014

Is Pelvic Exam in the Emergency Department Useful?

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

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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17 01, 2014

Should We Admit All Patients with Sternal Fractures?

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

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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