Bubble Time – A New, Simple Way to Detect RV Dysfunction
Spoon Feed
By agitating and injecting a saline flush into an IV catheter, right ventricular (RV) dysfunction was identified when bubbles were cleared from the RV at a time of ≥ 40 seconds with high sensitivity. It was ruled out as well with good specificity, with a bubble time < 40 seconds.
Source
Right Ventricular "Bubble Time" to Identify Patients With Right Ventricular Dysfunction. Ann Emerg Med. 2024 Aug;84(2):182-194. doi: 10.1016/j.annemergmed.2024.02.005. Epub 2024 Apr 10. PMID: 38597847.
Human, Take this Patient to the Cath Lab – AI and STEMI Detection
We have one wish...
Would you write a quick testimonial? A nice word from you is all we need 🥹!
If you have time this weekend...
Do you have suggestions for improvement? Give us your feedback about JournalFeed!
We need your input on wisely and ethically using AI. Also, see if you can you tell what's AI vs human-written.
Many thanks,
Clay
Spoon Feed
These researchers developed and trained a deep ensemble artificial intelligence (AI) model to classify ECGs as STEMI versus non-STEMI. The AI performed well in both accuracy and in improving sensitivity.
Source
Development of Clinically Validated Artificial Intelligence Model for Detecting ST-segment Elevation Myocardial Infarction. Ann Emerg Med. 2024 Jul 25:S0196-0644(24)00327-5. doi: 10.1016/j.annemergmed.2024.06.004. Epub ahead of print. PMID: 39066765.
Mechanism of Calcium for Hyperkalemia – Not What You Think
Spoon Feed
Giving calcium for hyperkalemia restores normal cardiac conduction velocity but does not restore resting membrane potential, as is commonly stated.
Source
Beneficial Effect of Calcium Treatment for Hyperkalemia Is Not Due to "Membrane Stabilization". Crit Care Med. Published online July 24, 2024. PMID: 39046789.
PROFUNDUS – POCUS-Plus for Aortic Syndromes
Spoon Feed
Using the aortic dissection detection (ADD) risk score in addition to point-of-care ultrasound (POCUS) and D-dimer, providers can increase their diagnostic accuracy and ensure that the appropriate patients are receiving advanced imaging to make the diagnosis of acute aortic syndrome (AAS).
Source
Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study. Eur J Intern Med. 2024 Jun 12:S0953-6205(24)00234-6. doi: 10.1016/j.ejim.2024.05.029. Epub ahead of print. PMID: 38871565.
Keith Wrenn Always Said, “Presyncope IS Syncope.” He Was Right
Spoon Feed
This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a 30-day period.
Source
Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. 2024 Jun 9. doi: 10.1111/acem.14943. Online ahead of print. PMID: 38853536
Is High-Sensitivity Troponin Actually Helping Us?
Spoon Feed
This RCT of U.S. patients being evaluated for acute MI using a 0/1 hour hs-cTnI protocol, compared to standard care with a 0/3 hour hs-cTnI protocol, didn’t find a difference in the percentage of patients discharged from the ED nor in the rates of 30 day death or MI.
Source
Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial. Ann Emerg Med. 2024 Jun 15:S0196-0644(24)00235-X. doi: 10.1016/j.annemergmed.2024.04.024. Epub ahead of print. PMID: 38888531.
Re-DOSE VF… DSED for Shock-Refractory VF?
Spoon Feed
This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks.
Source
The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial. Resuscitation. 2024 May;198:110186. doi: 10.1016/j.resuscitation.2024.110186. Epub 2024 Mar 24. PMID: 38522736.
The Ultimate Chest Pain Pathway? Not Quite
Spoon Feed
This was a validation study for the recently published American College of Cardiology (ACC) Expert Consensus Decision Pathway for chest pain. Results suggest this pathway is safe and efficacious for use in patients without known CAD; however, performance was not as good for patients with known CAD.
Source
Validation of the ACC Expert Consensus Decision Pathway for Patients With Chest Pain. J Am Coll Cardiol. 2024 Apr 2;83(13):1181-1190. doi: 10.1016/j.jacc.2024.02.004. Epub 2024 Mar 25. PMID: 38538196.
Point | Counterpoint – Adenosine First-Line for SVT?
Spoon Feed
Adenosine is an effective, rapid onset, short acting atrioventricular (AV) nodal blocker that can be used as a diagnostic aid for regular narrow and wide complex tachycardias and for definitive management for supraventricular tachycardia (SVT). It should remain first-line over calcium channel blockers (CCB) for SVT.
Source
Adenosine Should be First-Line Treatment for Supraventricular Tachycardia. Annals of Emergency Medicine. Published December 19, 2023. doi: 10.1016/j.annemergmed.2023.10.017
Point | Counterpoint – Calcium Channel Blockers First-Line for SVT?
Spoon Feed
Nondihydropyridine calcium channel blockers (CCB) are an efficacious option to treat supraventricular tachycardia (SVT) and do not cause the sense of doom that adenosine imparts. When taking into account CCB contraindications, diltiazem and verapamil could be first-line options for SVT.
Source
Calcium Channel Blockers Versus Adenosine for Paroxysmal Supraventricular Tachycardia. Annals of Emergency Medicine. 2024;83:394-395. https://doi.org/10.1016/j.annemergmed.2023.09.003