Articles related to Emergency Medicine

Navigating Asymptomatic Premature Ventricular Contractions: An Appropriate Management Approach In the realm of cardiac evaluations, understanding how to best manage asymptomatic premature ventricular contractions (PVCs) is of vital importance. The nuances of their manifestations and subsequent treatment protocols constitute the crux of this discussion.

Enhancing Cardiovascular Disease Risk Prediction: Comparing Coronary Artery Calcium and Polygenic Risk Scores A Northwestern University study revealed that both coronary artery calcium and polygenic risk scores significantly influence 10-year risk prediction for coronary heart disease. However, coronary artery calcium score demonstrated superior predictive power, reinforcing the integration of these novel tools in risk prediction models. “What this study says is that in white participants enrolled in 2 observational studies, identifying coronary calcium predicted future cardiac events better than our currently available polygenic risk scores.” Dr. Karol E. Watson, PhD, professor of medicine and cardiology at the David Geffen School of Medicine at the University of California Los Angeles

Dive into how the FDA-approved Farxiga is changing the heart failure treatment landscape. Colleagues, let’s dive into a remarkable milestone. Farxiga, known as dapagliflozin, now has FDA approval. This is groundbreaking for heart failure treatment. It applies to all patients, regardless of their left ventricular ejection fraction (LVEF) status. The approval didn’t happen overnight. Let’s talk about the DELIVER trial, a vital part of the process. It involved over 6,000 patients, all over 40. Each had heart failure, LVEF above 40%, and may or may not have had type 2 diabetes. They took either dapagliflozin or a placebo daily, plus their usual therapy. The trial had a clear goal: time to the first composite event. This included CV death, heart failure hospitalization, or an urgent heart failure visit. The goal applied to everyone, including patients with LVEF less than 60%. Fast forward about 2.3 years, the results were significant. Dapagliflozin cut the composite outcome by 18% versus the placebo. Both worsening heart failure and CV death rates dropped in the dapagliflozin group. The best part? These findings were consistent, even in patients with lower LVEF or diabetes. Expanding the picture, let’s consider two trials together: DELIVER and DAPA-HF. Over 22 […]

Navigate the complex world of diagnosing Chiari malformation in this insightful review of a clinical case. To understand Chiari malformation, let’s explore a clinical case. A mid-30s patient with a migraine history came to the ED with a sudden posterior headache. Accompanied by transient total body numbness, loss of coordination, and an inability to swallow with drooling, these symptoms started abruptly after violent sneezing. Although neurological symptoms faded after 20 seconds, the headache persisted. Regarding vital signs and physical examination, everything was normal. The patient had a head CT ordered. Interpreting the clinical picture and CT images with care is crucial in these cases. Even though a sudden onset headache could signify a ruptured berry aneurysm, no blood was detected on the CT cuts, minimizing that concern. Remember, an LP is seldom recommended if the CT is performed within 6 hours and hemoglobin exceeds 10 g/dL. However, the clinical presentation in this case, characterized by headache and drooling, didn’t match a typical migraine. Be mindful that many patients might loosely use the term “migraine” for any severe headache. The CT cut revealed a brainstem compressed by the cerebellum, indicative of a Chiari malformation type 1. Chiari malformation, characterized by an […]

This deep-dive into acromioclavicular joint injuries unpacks everything a physician needs to know about these prevalent injuries. Acromioclavicular joint (ACJ) injuries, mostly traumatic, can occur across all ages but are more frequent in males aged 20-40, often related to contact sports. Patients usually present with vague shoulder pain and swelling, but visible deformity is rare. Two mechanisms contribute to ACJ injuries: direct, resulting from a direct blow or fall onto the shoulder, and indirect, arising from a fall onto an outstretched hand or elbow. Imaging is crucial for diagnosis. The Rockwood system, among others, categorizes these injuries into six types. Plain radiographs, including an axillary view, generally suffice for accurate grading. However, in certain scenarios, CT or MRI might be necessary. In case of an injury suspicion with initial normal radiographs or contemplating surgical intervention on a type III injury, additional weight-bearing stress views can be beneficial. Indications of ACJ injury on a plain radiograph may include soft tissue swelling, acromioclavicular joint widening, increased coracoclavicular distance, and superior displacement of the distal clavicle. The treatment choice hinges largely on the patient’s age, lifestyle, and injury type. Conservative management typically applies to types I and II injuries, surgical treatment to types […]

In this video, Zack Shinar, MD, discusses the future of cardiac arrest and the role of extracorporeal membrane oxygenation (ECMO) in the emergency department (ED). Dr. Shinar is a leading expert in ECMO and has been instrumental in developing new protocols for its use in the ED. Dr. Shinar begins by discussing the current state of CPR. He notes that CPR is only effective in about 10% of cases, and that even when it is successful, patients often suffer significant brain damage. He then discusses ECMO, which is a life-support machine that can oxygenate the blood outside of the body. ECMO has been shown to be effective in saving the lives of patients with cardiac arrest, and Dr. Shinar believes that it should be used more widely in the ED. Dr. Shinar then discusses the challenges of using ECMO in the ED. He notes that ECMO is a complex procedure that requires specialized training and equipment. He also notes that ECMO can be expensive, and that it is not always available in all hospitals.