Lorenz Important Recent EM Papers
HEART Score was validated on 2440 patients in the Netherlands.
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.
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