Contributor: 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…
Read MoreContributor: Nick Hatch, MD Educational Pearls: Complete heart block or 3rd degree atrioventricular (AV) block is diagnosed via EKG and occurs when electrical signals from the sinoatrial (SA) node are blocked from reaching the ventricles via the AV node and AV bundles P waves and QRS complexes are independent Often QRS rate is around 40…
Read MoreContributor: Adam Barkin, MD Educational Pearls: Spontaneous coronary artery dissection (SCAD) is the most common cause of acute MI in women under 50 years old Risk factors include fibromuscular dysplasia, extreme exercise, stress, pregnancy, and recent birth Diagnosed in cath lab but medically managed and usually do not get a stent Treated with dual antiplatelet…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Refractory ventricular fibrillation, defined as 3 defibrillation shocks without resolution, was studied via RCT looking to compare ECMO with cardiac cath vs. typical resuscitation After 30 patients (15 each arm), the trial was stopped because such a significant benefit seen in the ECMO arm 6 patients survived and 3…
Read MoreContributor: Gretchen Hinson, MD Educational Pearls: Three episodes of ventricular tachycardia within 24 hours or two episodes back-to-back Treat with IV amiodarone and IV beta-blockers initially as well as IV lidocaine Correct underlying causes: IV magnesium for QT prolongation Replete potassium in hypokalemia Urgent revascularization in ischemia For refractory vtach, urgent radiofrequency ablation or stellate…
Read MoreContributor: Samuel Killian, MD Educational Pearls: Anecdotally, when the computer reads a triage EKG as normal it is most often normal One study tested this theory by examining 855 computer-read EKGS (222 of which were read as normal) Two cardiologists reviewed these 222 normal EKGs and only found 13 EKGs that were slightly abnormal with…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Epinephrine: alpha-1, alpha-2, beta-1, and beta 2 agonist – used in cardiac arrest with positive effects on ROSC in prehospital and peri-hopsital setting Norepinephrine: alpha-1 and beta-1 agonist – used in septic shock to increase cardiac output and peripheral vasoconstriction Phenylephrine: alpha-1 adrenergic agonist – used in spinal/neurogenic…
Read MoreContributor: Jared Scott, MD Educational Pearls: Small capsule pacemaker (2.5 cm, 1 ml volume) resides in the heart without any associated wires or leads like a traditional pacemaker The new version has a 6 year battery life, after which it can be deactivated and a traditional pacemaker put in place Cost is around 2-4 times…
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