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Electrocardiographic Findings in Pulmonary Emboli
Abstract Pulmonary embolism (PE) has become increasingly evident with the advent of new diagnostic testing. A large presentation spectrum can make the diagnosis and risk stratification difficult. We continue to look for useful ways to identify these patients since pulmonary emboli can lead to significant morbidity and mortality. A test of diagnostic utility is the electrocardiogram (ECG). It is reported that seventy percent of patients with PE have an abnormal ECG. We aim to evaluate the current literature on ECG changes and their utility in the diagnostic and prognostic evaluation of PE. (Source: Current...
Source: Current Emergency and Hospital Medicine Reports - April 19, 2015 Category: Emergency Medicine Source Type: research

The Impact of Risk Stratification of Venous Thromboembolism on Complexity and Site of Management
Abstract Acute venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE) is a disease state with a high incidence, producing substantial morbidity and mortality. Traditional treatment has been the initiation of parenteral anticoagulation and treatment with a vitamin K antagonist (VKA) such as warfarin. The development of low molecular weight heparin allowed treatment of uncomplicated DVT to be shifted towards the outpatient setting; PE, however, continues to be predominantly managed in the hospital. Non-vitamin K direct oral anticoagulants (NOACs) produce rapid an...
Source: Current Emergency and Hospital Medicine Reports - April 16, 2015 Category: Emergency Medicine Source Type: research

Natriuretic Peptide Goal-Directed Therapy: Are We There Yet?
Abstract Plasma B-type cardiac natriuretic peptides reflect cardiac structure and function, and have a proven role in the diagnosis of acute heart failure. Serial changes in plasma B-type cardiac natriuretic peptides parallel prognosis in chronic heart failure suggesting that intensified treatment directed at reducing B peptide concentrations may improve outcomes in heart failure (HF). This approach has been assessed in randomized trials conducted over the last 15 years. Meta-analyses of both summary and individual patient data indicate that adjustment of treatment in chronic HF according to serial B-typ...
Source: Current Emergency and Hospital Medicine Reports - April 9, 2015 Category: Emergency Medicine Source Type: research

Balancing Anti-thrombotic Efficacy and Bleeding Risk in the Contemporary Management of Venous Thromboembolism
In this study, we describe the evidence-based rationale for the use of these medications. We also discuss comparative bleeding risks, and the approaching to bleeding in the anticoagulated patient. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - April 7, 2015 Category: Emergency Medicine Source Type: research

Non-invasive Ventilation: A Gimmick or Does It Really Affect Outcomes?
Abstract Heart failure affects 5.1 million Americans every year and leads to over 900,000 annual emergency department (ED) visits. Of those patients, over 80 % will be admitted to the hospital. In the ED, treatment focuses on preload and afterload reduction through the use of diuretics and vasodilators. For those patients requiring oxygen, particularly those in respiratory distress, non-invasive ventilation improves symptoms by increasing ventilation, decreasing preload and afterload, decreasing work of breathing, and increasing gas exchange. Non-invasive ventilation is an effective intervention and is c...
Source: Current Emergency and Hospital Medicine Reports - April 7, 2015 Category: Emergency Medicine Source Type: research

ST2 in Heart Failure: Where Does This New Marker Fit in?
Abstract A member of the interleukin-1 receptor family, soluble ST2 (sST2), is a powerful marker of myocyte strain and vascular stress in heart failure and acute coronary syndrome, as well as numerous other cardio-pulmonary disease states. It is clinically useful in both the emergency department and hospital setting for predicting disease prognosis and mortality. Together with patient-specific characteristics, sST2 also has an increasing role to play as a tool to guide therapeutic interventions. We will discuss where this important new biomarker fits in now and its promise for the future. (Source: Current...
Source: Current Emergency and Hospital Medicine Reports - April 7, 2015 Category: Emergency Medicine Source Type: research

The Essentials of Bedside Ultrasound for Pulmonary Embolism
Abstract Pulmonary embolism (PE) is a potentially fatal condition if left untreated. Computed tomographic pulmonary angiography is widely used as the imaging modality of choice to diagnose a patient with suspected PE. Signs of right heart strain on echocardiography have poor sensitivity, but high specificity in the diagnosis of PE. In an unstable patient, bedside echocardiography may have a place in guiding the decision to administer either anticoagulation or thrombolytic therapy. In addition, bedside echocardiography may play a role in risk-stratifying patients into the submassive PE category. (Source: C...
Source: Current Emergency and Hospital Medicine Reports - April 5, 2015 Category: Emergency Medicine Source Type: research

New Drugs You are Going to Read About: Serelaxin, Ularitide, TRV027
Abstract Nitrovasodilators have long been used as first-line treatment for hypertensive acute heart failure (AHF). Although effective for BP control and symptom alleviation, this class of agents has never been shown to improve mortality or prevent hospital readmissions. Consequently, there has been tremendous interest in development of newer vasodilators with more beneficial therapeutic profiles. In this review, we focus on three of the most promising agents currently being studied: serelaxin, ularitide, and TRV027. While regulatory approval has yet to be obtained, should they prove beneficial in on-going...
Source: Current Emergency and Hospital Medicine Reports - April 2, 2015 Category: Emergency Medicine Source Type: research

Acute Heart Failure and Implantable Cardiac Devices in the Acute Care Setting
Abstract The use of implantable cardiac devices continues to increase in heart failure patients. The potential roles for these devices can include defibrillation, pacing, resynchronization, and physiologic monitoring. While referral for implantable devices generally occurs in the outpatient setting, an acute care encounter may provide an opportunity for recognition of a patient with an appropriate indication for a device. Therefore, we briefly discuss the indications for an implantable cardiac device in heart failure patients, so as to facilitate recognition and potential referral. We will also discuss th...
Source: Current Emergency and Hospital Medicine Reports - March 31, 2015 Category: Emergency Medicine Source Type: research

To Consult or Not to Consult: The Role of the Endocrinologist in the Management of Diabetes Mellitus in the Hospital Setting
Abstract Hyperglycemia in the hospitalized patient presents unique and frequent dilemma for the health care provider. The complications of hyperglycemia, whether due to diabetes mellitus or acute illnesses can have serious clinical and financial implication during hospitalization. What is the role of the endocrinologist in the hospitalized hyperglycemic patient? Does the endocrine consult in and of itself improve clinical and financial outcome, or is it the level of subject matter expertise of the clinicians that are treating the patient the more important factor in improving the quality outcomes? (Sourc...
Source: Current Emergency and Hospital Medicine Reports - January 29, 2015 Category: Emergency Medicine Source Type: research

The Role of Laboratory Evaluation in the Management of Hospital-Based DM: “When Did HbA1C Become an Inpatient Test?”
Abstract Hyperglycemia in the hospital setting is deleterious to patient outcomes. Patients with and without diabetes mellitus (DM) may present with hyperglycemia when they are acutely ill. The poor outcomes associated with hyperglycemia are potentially preventable with improved protocols to screen, diagnose, and treat DM in perioperative, critically ill, and non-critically ill patients. The role of lab tests, specifically the utility of hemoglobin A1C (HbA1c), in these scenarios is not well described. HbA1c is a rapid, cost-effective test that does not require a fasting blood sample. It can be used to sc...
Source: Current Emergency and Hospital Medicine Reports - January 23, 2015 Category: Emergency Medicine Source Type: research

Discharge Before Noon
This article will discuss the premise and possible structural process faults associated with the discharge before noon construct. (Source: Current Emergency and Hospital Medicine Reports)
Source: Current Emergency and Hospital Medicine Reports - January 22, 2015 Category: Emergency Medicine Source Type: research

Cardiac Ultrasound in Patients with Chest Pain
Abstract Chest pain is a frequent presenting complaint with a broad differential diagnosis. Emergency physicians routinely train in point-of-care cardiac ultrasound, which has the ability to rapidly and noninvasively assist in the diagnosis of many life-threatening causes of chest pain including acute coronary syndrome, cardiac tamponade, pulmonary embolism, and aortic dissection. In addition, the physician may quickly utilize other bedside ultrasound modalities, such as lung and musculoskeletal ultrasound, to diagnose pneumothorax, pneumonia, rib or sternal fractures, or soft tissue abnormalities. The ar...
Source: Current Emergency and Hospital Medicine Reports - January 21, 2015 Category: Emergency Medicine Source Type: research

The Two-Midnight Rule: A Review
Abstract Many years ago, The Center for Medicare and Medicaid Services (CMS) created a system where patients who did not meet specific criteria were determined to be ‘outpatients’ and placed under observation status in the hospital. This status was intended as enhanced outpatient treatment to rule out a diagnosis. The original definition of observation status has, however, transformed to a system where ‘outpatients’ are regularly placed in a hospital bed, taken care of by inpatient physicians and receive the same hospitalized care as ‘inpatients’. The financial impact to patients placed...
Source: Current Emergency and Hospital Medicine Reports - January 5, 2015 Category: Emergency Medicine Source Type: research

Pioneer ACO 3-Day SNF Waiver: CMS Offers Another Chance in a Shared Savings Model
Abstract Nearly 50 years ago, Medicare created a 3-day inpatient hospitalization requirement for the Medicare Part A eligibility of the post-acute care Skilled Nursing Facility (SNF) Benefit. The practice of Medicine in 1965 when the SNF benefit was created was completely different than care in today’s world. Multiple attempts at waiving this 3-day requirement have come and gone with variable and sometimes poor results. The original intent of the Health Care Financing Administrations’ (HCFA) 3-day requirement was to ensure appropriate utilization of resources for patients who truly needed skilled car...
Source: Current Emergency and Hospital Medicine Reports - December 24, 2014 Category: Emergency Medicine Source Type: research