Cardiovascular
Journal Jam 5 One Hour Troponin to Rule Out and In MI
Traditionally we've run at least 2 troponins 6 or 8 hours apart to help rule out MI and recently in algorithms like the HEART score we've combined clinical data with a 2 or 3 hour delta troponin to help rule out MI. The paper we'll be discussing here is a multicentre/multinantional study from the Canadian Medical Association Journal from this year out of Switzerland entitled "Prospective validation of a 1 hour algorithm to rule out and rule in acute myocardial infarction using a high sensitivity cardian troponin T assay" with lead author Tobias Reichlin. It not only looks at whether or not we can rule out MI using a delta troponin at only 1 hour but whether or not we can expedite the ruling in of MI using this protocol.
Best Case Ever 42 Pediatric Cardiac Arrest
When was the last time you saw ventricular fibrillation in a 4 month old? Dr. Simard tells his Best Case Ever of a Pediatric Cardiac Arrest in which meticulous preparation, sticking to his guns, early activation of the transportation service, and clever use of point of care ultrasound helped save the life of a child. He explains the importance of debriefing your team after an emotionally charged case.
Episode 72 ACLS Guidelines 2015 Post Arrest Care
Once we've achieved ROSC our job is not over. Good post-arrest care involves maintaining blood pressure and cerebral perfusion, adequate sedation, cooling and preventing hyperthermia, considering antiarrhythmic medications, optimization of tissue oxygen delivery while avoiding hyperoxia, getting patients to PCI who need it, and looking for and treating the underlying cause. Dr. Lin and Dr. Morrison offer us their opinion on the new simplified approach to diagnosing the underlying cause of PEA arrests. We'll also discuss when it's time to terminate resuscitation or 'call the code' as well as some fascinating research on gender differences in cardiac arrest care. These co-authors of the guidelines will give us their vision of the future of cardiac arrest care and we'll wrap up the episode with a third opinion, so to speak: Dr. Weingart's take on the whole thing....
Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1
A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen steadily over the last decade. With the release of the 2015 American Heart Association ACLS Guidelines 2015 online on Oct 16th, while there aren’t a lot a big changes, there are many small but important changes we need to be aware of, and there still remains a lot of controversy. In light of knowing how to provide optimal cardio-cerebral resuscitation and improving patient outcomes, in this episode we’ll ask two Canadian co-authors of The Guidelines, Dr. Laurie Morrison and Dr. Steve Lin some of the most practice-changing and controversial questions.
Episode 64 Highlights from Whistler’s Update in EM Conference 2015 Part 2
In this Part 2 of EM Cases' Highlights from Whistler's Update in EM Conference 2015 Dr. David Carr gives you his top 5 pearls and pitfalls on ED antibiotic use including when patients with sinusitis really require antibiotics, when oral antibiotics can replace IV antibiotics, how we should be dosing Vancomycin in the ED, the newest antibiotic regimens for gonorrhea and the mortality benefit associated with antibiotic use in patients with upper GI bleeds. Dr. Chris Hicks gives you his take on immediate PCI in post-cardiac arrest patients with a presumed cardiac cause and The Modified HEART Score to safely discharge patients with low risk chest pain.
Best Case Ever 34: Inferior MI Presenting with Abdominal Pain
In a previous Best Case Ever, 'Thinking Outside the Abdominal Box', Dr. Brian Steinhart reviewed some important can't-miss-diagnoses that can present elusively with abdominal pain. In this Carr's Cases Series on Inferior MI Presenting with Abdominal Pain, we continue in the theme of 'Thinking Outside the Abdominal Box' with David Carr explaining how he figured out that a man presenting with classic biliary colic was diagnosed with an inferior MI with right ventricular extension.
