Modified Sgarbossa Criteria: Ready for Primetime?

The 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…)

By Salim Rezaie, MD|2016-11-11T19:17:42-08:00Dec 3, 2013|Cardiovascular, ECG|

Elder Abuse and Neglect: What to do in the Emergency Department

help concept, special toned photo f/x, focus point selective Have you ever identified elder abuse in a patient in your ED? The signs can often be subtle, can look like one of many other medical or traumatic problems, and can be mistaken for aging-related changes. This is an unpleasant topic, but rather than bury our heads in the sand and pretend it doesn’t happen, let’s face it and see what we can do to intervene and help. How can you miss it less often? And what are your legal obligations if you suspect elder abuse?

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By Christina Shenvi, MD, PhD, MBA|2016-11-27T12:38:12-08:00Dec 2, 2013|Geriatrics|

Subsegmental Pulmonary Embolisms (SSPE) are Important

Multi-detector computed tomographic pulmonary angiography (CTPA) allows for better visualization of peripheral pulmonary arteries allowing for diagnosis of small peripheral emboli limited to the subsegmental pulmonary arteries. Interestingly as these SSPE’s get diagnosed more and more, two questions come to mind:

What is the prognostic utility of diagnosing SSPEs?
What is the morbidity and mortality of SSPEs compared to more proximal PEs?

A recent study in 2013 Blood looked at these questions. ¹

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By Salim Rezaie, MD|2019-09-10T13:35:08-07:00Nov 27, 2013|Cardiovascular, Critical Care/ Resus, Pulmonary|

The Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy

Health-care associated pneumonia (HCAP) is the term used to describe patients presenting with pneumonia who may be at higher risk of multi-drug resistant (MDR) pathogens than other patients presenting from the community due to recent contact with the health care system. What are the criteria for HCAP?

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By Emily Heil, PharmD, BCPS, AAHIVP|2016-11-11T19:17:36-08:00Nov 26, 2013|Infectious Disease, Pulmonary|

Shock Index: A Predictor of Morbidity and Mortality?

Emergent airway management and severe sepsis are both high-risk situations that are commonly encountered by emergency physicians. It is well known that complications can be high in both situations, which in turn can lead to increased morbidity and mortality. For instance, about 1/4 of patients who are hemodynamically stable prior to intubation get post-intubation hypotension (PIH) after rapid sequence intubation. Also septic patients may not be reliably identified by systemic inflammatory response syndrome (SIRS) markers early in their disease course. The Shock Index (SI) may be an adjunct that is easy to calculate and could predict both PIH and severe sepsis.

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By Salim Rezaie, MD|2019-09-10T13:35:16-07:00Nov 25, 2013|Critical Care/ Resus, Expert Peer Reviewed (Clinical)|

ALiEM Journal Club Question 4: Reimbursement Tied to Diagnosis

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 4 on the topic of reimbursements tied to diagnosis:

The Centers for Medicare & Medicaid Services (CMS) proposed instituting a new process metric OP 15 “Use of Brain CT in the Emergency Department of Atraumatic Headache.” OP 15 measures the percentage of ED visits for atraumatic headache (ie, ED billing codes for tension, cluster, migraine, and nonspecific headaches) among Medicare beneficiaries who have a brain CT performed on the same day. ED patients who are admitted to the hospital and those whose secondary diagnoses include codes related to subarachnoid hemorrhage, transient cerebral ischemia, and tumor/mass are excluded from the denominator. The public reporting of OP 15 is presently postponed to allow time for refinement of the measure by a technical expert panel. However, if this indicator is fully instituted, would the threat of decreased reimbursement and public reporting of use decrease your ordering of CTs in patients older than 65 years and with atraumatic headaches?

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By Michelle Lin, MD|2016-11-13T09:43:24-08:00Nov 19, 2013|Journal Club|

ALiEM Journal Club Question 3: Malpractice and CT Use

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 3 on the topic of malpractice and CT use:

Discuss some of the important differences between the current health care systems and medical malpractice environments in Canada and the United States. How might these differences affect CT use in the emergency department (ED)? How might the implementation of the Patient Protection and Affordable Care Act in the US affect these differences?

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By Michelle Lin, MD|2016-11-13T09:43:24-08:00Nov 19, 2013|Journal Club|