Author: Nick Hatch, M.D.
- CPR-induced consciousness is a phenomenon that occurs when someone who was previously unconscious and is undergoing CPR regains consciousness and makes purposeful movements.
- Studies have shown that this phenomenon is increasing, likely because of increased quality of CPR.
- Many people use a sedative such as ketamine to keep patients unconscious to reduce the psychologic trauma of CPR.
- 39% of people who survive CPR with good neurologic details remember the process of CPR.
Joshua Pound, P. Richard Verbeek, and Sheldon Cheske. CPR Induced Consciousness During Out-of-Hospital Cardiac Arrest: A Case Report on an Emerging Phenomenon. 2017. Prehospital Emergency Care Vol. 21.
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Author: Sam Killian, M.D.
- Not every troponin elevation is an MI.
- Trop elevates in about an hour in ACS and stays elevated for days.
- Non-MI conditions that cause elevated troponin: Critical illness (sepsis), increased cardiac demand, right heart strain, LV dysfunction, hypotension, pressor use, acute PE, SAH, chronic renal failure, CHF, aortic dissection, and peri/myocarditis.
- Elevated troponin in settings other than MI is correlated with increased mortality.
References: Korff S, Katus HA, Giannitsis E. Differential diagnosis of elevated troponins. Heart. 2006;92(7):987-993. doi:10.1136/hrt.2005.071282.
Author: Aaron Lessen, M.D.
- Atrial fibrillation is common.
- One of the best treatments for a fib is cardioversion back into sinus rhythm.
- Cardioversion may increase stroke risk if A-Fib duration is greater than 48 hours, but some new data suggests that this risk may happen as soon as 12 hours.
- However, newer studies show that cardioversion is generally safe as a treatment for A-Fib.
References: Aatish Garg, Monica Khunger, Sinziana Seicean, Mina K. Chung, Patrick J.Tchou Incidence of Thromboembolic Complications Within 30 Days of Electrical Cardioversion Performed Within 48 Hours of Atrial Fibrillation Onset. JACC: Clinical Electrophysiology Aug 2016, 2 (4) 487-494; DOI: 10.1016/j.jacep.2016.01.018
Author: Michael Hunt, M.D.
- Oats have been shown to lower LDL.
- Oat bran is the most effective way to consume oats to lower LDL.
- A Swedish study of 69,000 people who ate at least 3 servings of potatoes a week showed no increased risk of a MI or stroke associated with potato consumption.
References: Larsson SC, Wolk A. Potato consumption and risk of cardiovascular disease: 2 prospective cohort studies. Am J Clin Nutr. 2016
Author: Michael Hunt, M.D.
- Research has shown that the higher temperatures post-cardiac arrests may lead to poorer outcomes.
- Initially, 33 deg C was the target temp. However, more research is being done to find therapeutic temperature levels.
- New studies have shown that the cooling protocol differs for inpatient cardiac arrests vs. outpatient cardiac arrests. The results show that it may not be necessary to cool inpatient cardiac arrests.
Author: Aaron Lessen M.D.
- Thoracotomy is a potentially life-saving procedure. However, outcomes are often poor and the procedure itself poses many risks to provider and patient.
- Chance of surviving a thoracotomy when there is no cardiac activity on ultrasound is 0%.
- Performing a thoracotomy is unlikely to benefit patients with no cardiac activity on ultrasound or patients that lost vital signs greater than 10 minutes before starting the procedure.
- A thoracotomy is maximally beneficial in patients with a penetrating chest injury that occurred less than 10 minutes before the procedure.
References: K. Inaba et al, “FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation” Ann. of Surgery, 2015. https://www.ncbi.nlm.nih.gov/pubmed/26258320
Author: Aaron Lessen M.D.
- Zofran (ondansetron) is generally safe to use for the treatment of nausea and vomiting. However, it can prolong the QT interval and increase the chance for torsades.
- Low doses of Zofran are not likely to be an issue. However, when multiple doses are given, especially in the setting of a preexisting LQTS, clinical concern should be raised.
- When giving Zofran to a patient with an increased risk for torsades, consider continuous cardiac monitoring or an alternate anti-emetic.
Author: Dylan Luyten M.D.
- Ashman’s Phenomenon occurs in the setting atrial fibrillation and mimics ventricular tachycardia, but is harmless.
- On ECG, the pattern of Ashman Phenomenon is a long cycle, followed a short cycle, followed by a complex wide complex beat.
- The wide complex beats have right BBB morphology. The long R-R followed by a short R-R leads to conduction down the left bundle branch while the right bundle branch is still in a refractory period.
Author: Samuel Killian M.D.
- Lower extremity DVTs are extremely common. There are more left lower extremity DVT due to anatomical variation.
- May-Thurner Syndrome is a form of anatomical variation in which the left iliac artery compresses the left iliac vein.
- Anticoagulation may not be sufficient to treat those with May-Thurner syndrome – endovascular stenting may be needed
- Patients with with recurrent LLE DVT, especially those in whom anticoagulation fails, should be referred to a specialist.
References: Peters M, Syed RK, Katz M, et al. May-Thurner syndrome: a not so uncommon cause of a common condition. Proceedings (Baylor University Medical Center). 2012;25(3):231-233. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377287/
Run Time: 3 minutes
Author: Michael Hunt M.D.
- Frostbite injuries are graded by the severity of tissue depth.
- A Grade 1 injury has no cyanosis of the tissue, and usually just redness is present.
- A Grade 2 injury has acral cyanosis.
- A Grade 3 injury has cyanosis past the mid phalanx of the digits, resulting in a high chance of amputation.
- A Grade 4 injury has cyanosis beyond metacarpal/metatarsal phalangeal joints, and almost certain amputation.
- Treatment for frostbite is gradual rewarming in water of 100-104 degrees fahrenheit. If a patient has injuries to all 4 extremities the entire patient can be placed into a warm bath.
- It is suggested that IV or intra arterial tPA can also be used to improve salvage of the digits because ice crystals form in the tissues when frostbite occurs, and when the patient is rewarmed they can be subjected to clotting.
- The tPA must be started within 24hrs of rewarming – the time that the patient suffered the frostbite injury is not as important.
Link to Podcast: http://medicalminute.madewithopinion.com/frostbite/