Contributor: Jared Scott, MD Educational Pearls: Variability of organisms in infecting the myocardial valves Duke Criteria for Infective Endocarditis includes three categories that can be used to definitively diagnose endocarditis Pathologic Criteria pathological evidence of infection Major Clinical Criteria positive blood cultures positive echocardiogram findings (TEE is more sensitive than a TTE) Minor Clinical Criteria…
Read MoreEducational Pearls: Glucagon can be used to treat hypoglycemia and esophageal foreign body, but it can also be used in beta-blocker toxicity to bypass cardiac beta-blockade The superior option for treating bradycardia due to beta-blocker toxicity is glucagon Glucagon has decreased efficacy in patients with heart failure, so increased doses up to 10 mg might…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Pulse checks are necessary during CPR to check for return of spontaneous circulation (ROSC) Previous studies have shown that assessing ROSC with palpating for pulse are not a very consistent Study compared palpating pulses at carotid/femoral artery versus a newly contrived gold standard for pulse checks The gold…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Study of nearly 400 patients evaluating giving calcium during cardiac arrest with the endpoint as return of spontaneous circulation (ROSC) Compared giving 1 amp calcium chloride with each round of epinephrine for the first two rounds of epinephrine versus saline placebo ROSC occurred in 19% of patients in the…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Meaningful survival under 10% for out of hospital cardiac arrest The most common cause of out-of-hospital cardiac arrest is due to cardiac ischemia Study looked at whether taking patients without ST elevation who had an out-of-hospital cardiac arrest with return of spontaneous circulation (ROSC) should receive angiography upon arrival…
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stemi or stemi mimic? that is the question Chief Complaint: Chest Pain HPI 24-year-old male with no past medical history presents to the ER with left-sided chest pain since 7 AM. The pain started while he was riding his bike, reliably when his heart rate was above 130 on self-monitoring. He reports pain then radiated…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Recent retrospective cohort study looked at elevated BP readings in the ED and correlation to underlying hypertension Large cohort of over 30,000 patients found that nearly 50% had an elevated blood pressure reading in the ED Less than 15% of patients with elevated BP readings in the ED were…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Kounis syndrome is an allergic acute coronary syndrome Triggers include medications (antibiotics), insect bites, or other common allergens Believed to be due to mast cell activation, inflammatory cytokines, and platelet activation causing coronary vasospasm or plaque rupture in setting of existing atherosclerosis Consider Kounis syndrome in the setting of…
Read MoreContributor: Peter Bakes, MD Educational Pearls: ST elevation clinical guidelines for myocardial infarction include: 2.5 mm elevation for males <40 in V2 and V3 2 mm elevation in males >40 in V2 and V3 1.5 mm elevation for females in V2 and V3 1 mm elevation in 2 or more contiguous leads (not V2 or…
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