Does Negative CTPA Rule Out High Pretest Probability PE?

Does Negative CTPA Rule Out High Pretest Probability PE?

For patients with high pretest probability for pulmonary embolism, a negative CT pulmonary angiography alone does not appear to adequately rule out venous thromboembolism.

Can We Use Beta-Blockers With COPD?

Can We Use Beta-Blockers With COPD?

Patients with cardiovascular disease and concomitant COPD can be safely treated with a combination long-acting beta-agonist and a long-acting muscarinic antagonist when on a baseline beta-blocker.

No Antibiotics for Diverticulitis...and other stuff the residents taught me this week

No Antibiotics for Diverticulitis...and other stuff the residents taught me this week

After almost twenty years as a doctor, constantly reading, it never ceases to amaze me how much I still don't know.  One of the highlights of my job is working with great residents who also teach me.  This week was no exception.  Here are two things I learned from our residents this week.

IOTA - Oxygen, Less Is More

IOTA - Oxygen, Less Is More

For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

Syncope/Pre-syncope and Outcome in PE Patients

Syncope/Pre-syncope and Outcome in PE Patients

Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission.  Don't try to treat them as an outpatient.

Stop Anticoagulants for Nuisance Bleeding?

Stop Anticoagulants for Nuisance Bleeding?

Nuisance bleeding in patients with atrial fibrillation on oral anticoagulants did not portend subsequent major bleeding or increased risk for stroke/systemic embolism.

Time to Epi for Non-Shockable Rhythm Matters

Time to Epi for Non-Shockable Rhythm Matters

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

ECG Predictors of Arrhythmia in Syncope

ECG Predictors of Arrhythmia in Syncope

In the evaluation of older patients with syncope, certain ECG abnormalities increase the risk of 30-day serious cardiac arrhythmias. These ECG abnormalities include non-sinus rhythm; multiple premature ventricular conductions; short PR interval; first degree atrioventricular block; complete left bundle branch block; and ST, T, and Q-wave abnormalities consistent with acute or chronic ischemia.

Fast PEA | Slow PEA - Survival Difference

Fast PEA | Slow PEA - Survival Difference

There is a difference between PEA rhythms.  Slow rates of electrical activity had the usual dismal prognosis.  But those with electrical rates >60 had survival and favorable neurological outcome comparable to VF/VT, 22% and 15% respectively.

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