Conference Notes 9-5-2018

Lorenz       Important Recent EM Papers

HEART Score was validated on 2440 patients in the Netherlands.

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Procamio Study  June 2016

Procainamide works better than Amiodarone for stable v-tach with less adverse events.

Revert Study August 2015

Initially attempt to treat SVT with postural modification to valsalva maneuver. Put head of bed at 40 degrees and have patient blow in syringe for 15 seconds. Then lay patient flat and raise legs.  Then sit them back up.

 Try this modified valsalva maneuver to terminate SVT. It works 25% of the time.

Try this modified valsalva maneuver to terminate SVT. It works 25% of the time.

Dr. Lovell comment: If patient has alot of anxiety about adenosine, consider propofol to sedate patient.

Aromatherapy vs Zofran Study      August 2018

Olfactory distraction works for nausea. For patients who don't have an IV and have nausea, Inhaled isopropyl alcohol from an alcohol wipe works as well or better than zofran.   Consider this for a patient with nausea. Patients get relief for 30-60minutes.

Haldol for Gastroparesis    Acad Emerg Med 2017

5mg IM was very effective for gastroparesis symptoms.

Dr. Lovell comment: Haldol treats both pain and nausea.  Watch for QT prolongation

Treating Hypokalemia with Low-dose insulin

In patients with CKD/ESRD,  5u of insulin works just as well as 10u of insulin with much less hypoglycemia.

Flomax for Kidney Stones 2018

For stones in the distal ureter, 4-7mm, flomax worked better, faster, with less painful passage of stone. Number needed to treat is high though.  Avoid flomax in patients with risk factors for CAD.

BICAR-ICU Study

Bicarb for anion gap acidosis in the ICU did not lessen mortality or organ failure but it did decreased the need for dialysis.

Dr. Lovell: This study is a game changer for acidotic patients.  Most of these patients with anion gap acidosis had sepsis.

PEITHO   Systemic TPA for PE

Normotensive PE patients with RV strain on echo who got TPA and heparin did not have improved mortality compared to heparin alone. TPA patients did have greater adverse bleeding outcomes.

Procedure Lab