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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, May 29, 2014

SAEM 2014 (FOAMed report)

medpage Today - Published: May 22, 2014 - By Elbert Chu, Associate Producer
"In this Society for Academic Emergency Medicine 2014 edition of the FOAMed report, we reached out to Salim Rezaie, MD, for his top picks from the meeting. Rezaie is assistant program director of emergency medicine at the University of Texas Health Science Center in San Antonio. He's also founder of R.E.B.E.L. EM, where his team evaluates emergency medicine literature.
Rezaie's Eight "Best things I learned from SAEM":
  1. "Wake-up" stroke occurs in 16% to 30% of stroke patients. CT angiography/CT perfusion may have a role to help identify early-onset lesions to be considered for thrombolytics. MRI diffusion-weighted images/fluid attenuated inversion recovery (FLAIR) images may also be used to identify early strokes to be considered for thrombolytics, according to the WAKE-UP Trial.
  2. Identify central versus peripheral causes of vertigo in younger patients with HINTS -- it's better than an ABCD2 score.
  3. Use video-oculography (VOG) like eye ECG to evaluate dizziness -- it's expensive but can save admissions.
  4. When in doubt about lorazepam versus diazepam for pediatric status epilepticus ... diazepam is better.
  5. Low-dose ketamine (0.3mg/kg) can be used for severe acute pain in the ED. (Study is not yet published, but we covered ketamine at the AAEM meeting).
  6. Here are five imaging exams physicians and patients should discuss before ordering, from the American College of Radiology.
  7. Fibrinolytic therapy reduced progression to hypotension (massive pulmonary embolism) but increased intracerebral hemorrhage (ICH) rate. All patients with ICH were ages 75 years or older, via the PEITHO Trial.
  8. Treat symptomatic pulmonary embolism with oral rivaroxaban. The EINSTEIN-PE Trial found that the rivaroxaban pill can be safely used instead of Lovenox injections and Coumadin INR checks."