Rezaie’s Evidence-Based Evidence of the Literature

Management of Syncope

“Done Fell Out”, or DFO, is a common saying in the South to describe syncope. Although the saying is funny the diagnosis is not. Syncope accounts for about 3–5% of ED visits and 1–6% of hospital admissions. In patients >65, syncope is the 6th most common cause of hospitalization.

How do you approach the management of patients with syncope?

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2019-02-19T18:07:51-07:00

Chest Pain: Coronary CT Angiography in the ED

CT ScannerIt is well known that taking a good history and physical, getting a non-ischemic EKG, and serial cardiac biomarkers, results in a risk of death/AMI of <5% in 30 days. Patients, in whom you still suspect have CAD, should undergo provocative testing within the next 72 hours based on the AHA/ACC guidelines. Their guidelines deem provocative testing as including:

  • Exercise treadmill stress test,
  • Myocardial perfusion scan,
  • Stress echocardiography, and/or
  • Coronary CT angiography (CCTA).

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2016-11-11T18:38:52-07:00

NG Lavage: Indicated or Outdated?

Nasogastric lavage (NGL) seems to be a logical procedure in the evaluation of patients with suspected upper GI bleeding, but does the evidence support the logic? Most studies state that endoscopy should occur within 24 hours of presentation, but the optimal timing within the first 24 hours is unclear.  Rebleeding is the greatest predictor of mortality, and these patients benefit from aggressive, early endoscopic hemostatic therapy and/or surgery. So what are the arguments for and against NGL?

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2016-11-11T18:39:14-07:00

Chest Pain: What is the Value of a Good History?

Chest Pain Check List copyEvery year there are 6 million visits to the Emergency Department (ED) for chest pain, and approximately 2 million hospital admissions each year.1 This is approximately about 10% of ED visits and 25% of hospital admissions with 85% of these admissions receiving a diagnosis of a non-ischemic etiology to their chest pain (CP).2 This over triage has enormous economic implications for the US health care system estimated at $8 billion in annual costs.

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2016-12-16T10:52:43-07:00

Ketofol: Is this the “Game Changer” of Procedural Sedation and Analgesia?

When talking about procedural sedation and analgesia, our goal is to minimize pain and anxiety, with the appropriate agent that matches the needs of our patient and the clinical scenario. So what are some qualities of this “ideal agent?”

In a perfect world, it would have:

  • Minimal adverse effects
  • Rapid onset and offset of action
  • Pharmocokinetic predictability across a spectrum of patients

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2017-05-11T14:27:23-07:00

Lytics for sub-massive PE: Ready for primetime?

PulmonaryembolismThere was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al1, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs.

Should we be considering tPA in patients with sub-massive PEs?

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2016-11-11T18:39:33-07:00