April 2023

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Previous guidelines suggested that isolated aVR elevation with multi-lead ST depression could be considered as a STEMI equivalent. However, current evidence suggests aVR elevation is not specific for an acute coronary event.

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Does ST Elevation in Lead aVR Require an Emergent Trip to the Catheterization Laboratory? JAMA Intern Med. 2023 Mar 1;183(3):261-262. doi: 10.1001/jamainternmed.2022.5901.

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Pregnant patients who present with signs and symptoms concerning for PE can be safely evaluated using Wells criteria or the YEARS algorithm. 

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Noninvasive diagnostic work-up for suspected acute pulmonary embolism during pregnancy: a systematic review and meta-analysis of individual patient data. J Thromb Haemost. 2023 Mar;21(3):606-615. doi: 10.1016/j.jtha.2022.11.025. Epub 2022 Dec 22.

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Video laryngoscopy (VL) has shown advantages over direct laryngoscopy (DL) in the literature, but should it be the primary approach to intubation? These two anesthesiologists debate.

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This well-designed RCT finds early administration of 4-factor prothrombin complex concentrate (PCC) to patients at risk of receiving massive transfusion protocol (MTP) did not reduce 24-hour blood product consumption or mortality but did increase thrombotic events.

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Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients With Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. JAMA. 2023 Mar 21. doi: 10.1001/jama.2023.4080. Online ahead of print.

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Though incremental progress has occurred over the last several decades, inequities loom for people that wish to become pregnant during medical training.

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Pregnancy and Residency - Overdue for Equity. N Engl J Med. 2023 Mar 16;388(11):966-967. doi: 10.1056/NEJMp2215288. Epub 2023 Mar 11.

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Hyperacute T-waves are best conceptualized as being tall and wide relative to the size of the QRS complex, as well as abnormally symmetric, and can be used to aid in early identification of an acute coronary occlusion.

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Hyperacute T-waves Can Be a Useful Sign of Occlusion Myocardial Infarction if Appropriately Defined. Ann Emerg Med. 2023 Mar 3:S0196-0644(23)00025-2. doi: 10.1016/j.annemergmed.2023.01.011. Epub ahead of print.

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In this secondary analysis of the ALPS trial (Amiodarone, Lidocaine, or Placebo Study), researchers found that early administration of amiodarone (within 8 minutes) is associated with greater functional survival in OHCA with initial shockable rhythm when compared to placebo.

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Survival by Time-to-Administration of Amiodarone, Lidocaine, or Placebo in Shock-Refractory Out-of-Hospital Cardiac Arrest. Acad Emerg Med. 2023 Mar 4. doi: 10.1111/acem.14716. Epub ahead of print.

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Patients who required hemorrhage control surgery after major trauma and were intubated in the ED had higher rates of adverse outcomes than those intubated in the OR. Importantly, patients with “clinical indications for intubation” were excluded from analysis.

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Hydrocortisone treatment for patients with severe community-acquired pneumonia was associated with reduced 28-day mortality and no increase in major adverse events.

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Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145. Online ahead of print.

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ChatGPT is an artificial intelligence software that is being explored for scientific writing. While there is great potential for utilizing this in the medical field, it should not be used in isolation and requires human oversight for both concept proof and personalization.

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Can artificial intelligence help for scientific writing? Crit Care. 2023 Feb 25;27(1):75. doi: 10.1186/s13054-023-04380-2.