In last week’s post, we reviewed Pluymaekers et al (1), a randomized control trial from the Netherlands on early or delayed cardioversion for recent-onset atrial fibrillation (AF). In this post, we will analyze our practice in the U.S. and discuss some of the arguments for and against cardioversion in the Read more…
Kudos to Dr. Beth Hanson. One of our recently graduated fourth-year residents, who will be an attending in Colorado, went above and beyond the call of duty just a few weeks ago. Dr. Aleksandr Gleyzer nominated Dr. Hanson for acknowledgment. It was a relatively busy CCT shift when Dr. Hanson Read more…
A recent NEJM article, “Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation” by Pluymaekers et al has reinvigorated debate in the blogosphere, academia conference halls, and podcast-dom over management of recent-onset atrial fibrillation (AF) (1,2,3). Prior studies have demonstrated that cardioversion for recent-onset atrial fibrillation (typically defined by a duration Read more…
From the last two posts (Part 1 and Part 2) we know that observing patients for chest pain to “rule out ACS” may no longer be relevant now that we have new diagnostic modalities and updated evidence. The tests we do in the observation unit are unlikely to help us Read more…
This month’s Save of the Month goes to Dr. Eric (Every)Rose(Has Its Thorn)Man. The Case A 53-year-old male with no reported past medical history presented with “sudden left side chest pain” x 15 mins. Vitals in triage were as follows: HR 125/min BP 163/113 mm Hg RR 20/min SpO2 Read more…
Last week’s post described the history of observation units, and how technology and knowledge has advanced since the early days of observation. Now, we are identifying more MIs in the ED and safely discharging a large swath of low-risk chest pain patients. So, who is left for observation? Are there Read more…
Accurate and expeditious diagnosis of acute myocardial infarction or acute coronary syndrome (ACS) is one of the key charges of emergency medicine providers. Chest pain is the second most common reason for emergency department visits in the United States and coronary artery disease is our leading cause of death (1,2). Read more…
Here are some highlights from our weekly education conference from May 1, 2019. Dr. Andy Wong gave his senior lecture on “Things That Sting You”: Fire Ants sting you They are found in the Southeast US Local care for stings is all that’s needed – use ice for pain and Read more…
A 65-year-old male with history of diabetes mellitus type 2, hypertension, and hypothyroidism presented to the ED with nausea and vomiting that began that morning. He also reported generalized weakness and decreased exercise tolerance. Upon initial presentation, the patient had a heart rate of 109 per minute, blood pressure 107/68 Read more…
February’s Food & Journal Club (FJC) article was chosen by one of the senior residents to open up a discussion regarding evaluation of chest pain in the ED and the utility of the HEART score in our patient population. The gracious Dr. Stetz hosted, the venerable Dr. Wiener presided, and Read more…