DOACs Update

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WHAT ARE THE DOACs?

The term direct oral anticoagulants (DOACs, previously NOAC for novel oral anticoagulants) describes two classes of medications: direct thrombin inhibitor and factor Xa inhibitors. These drugs provide alternative oral anticoagulation options for management in non-valvular atrial fibrillation and venous thromboembolism without the need for specific dietary restrictions or monitoring typically required for patients taking vitamin K antagonists.

 

Drug Class Uses Evidence Half-Life
Dabigatran (Pradaxa) -Direct thrombin inhibitor
-First oral direct thrombin inhibitor
-Approved by FDA in 2010
-AFib*
-DVT/PE
-VTE prophylaxis ...
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Joe D’Orazio: Temple EM toxicologist and media darling, talks opioid epidemic

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Joe D’Orazio, Temple EM’s beloved medical toxicologist and assistant professor of emergency medicine, has quickly become Philadelphia’s go-to resource on the opioid epidemic.

Here are some of his recent features in the local media:

Are discarded hypodermic needles a public health threat?
Opioid-related hospitalizations soar in Pennsylvania
Overdose just by touching fentanyl? Highly unlikely, experts say
Faculty join city task force to fight opioid crisis

 

Dr. D’Orazio has also started a toxicology consultation service and suboxone clinic at Temple. ...

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A Glenohumeral Situation

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Temple GEM of the Week
By: Adria Simon
Edited by: Alexei Adan, Danielle Betz & Maura Sammon
Case: A 39 year old M presented complaining of L shoulder pain after an assault. Pt was attempting to break up a domestic altercation and was thrown to the ground, struck with fists. On exam ...
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Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children

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The Article:

“Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children” The New England Journal of Medicine. 2016; 375: 2446-56.

The Idea:

Aside from the common cold, acute otitis media is the most frequently diagnosed illness in children in the United States and currently is the most common indication for antimicrobial treatment. Previous studies have shown a clear benefit of 7-10 days of antibiotic therapy when compared to placebo in treating children less than 3 years of age with AOM. With growing ...

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Effectiveness of Screening for Life-Threatening Chest Pain in Children

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The Study: Effectiveness of Screening for Life-Threatening Chest Pain in Children

Pediatrics June, 2011

http://pediatrics.aappublications.org/content/pediatrics/128/5/e1062.full.pdf

Background:

Pediatric chest pain is a high volume chief complaint that is rarely caused by significant pathology. The workup is often quite variable among physicians and many times results in a high amount of referrals and utilization of pediatric cardiologists. These prolonged and often unfinished workups result in missed school/sports, anxiety, and fear of exercise. Studies like this are helpful for developing guidelines for assessment and management pathways that will help ...

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Single-Dose Oral Dexamethasone for Asthma Exacerbations in Children

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The Article: Altamimi, Saleh, et al. “Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma.” Pediatric emergency care 22.12 (2006): 786-793.

The Idea: Compare single-dose oral dexamethasone versus multidose prednisolone to determine if one-time dose of 0.3mg/kg dexamethasone in the emergency room can result in better resolution of symptoms on day 4 when compared to 1mg/kg of prednisolone for 3 days.  Key metric was PRAM (Pediatric Respiratory Assessment Measure) which measures work of breathing, air entry, wheezing, ...

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The Difficult Pediatric Airway: Lessons from the PeDI Registry

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The Article:

Airway management complications in children with difficult tracheal intubation from the Pediatric Difficult Intubation (PeDI) registry: a prospective cohort analysis. Fiadjoe, J., et al. The Lancet, 2015.

The Idea:

Create a registry to characterize complications and identify risks for bad outcomes with difficult pediatric airways. Use the results to suggest strategies to make pediatric airway management successful.

The Study:

This study was a prospective observational study carried out at multiple US academic children’s hospitals that evaluated the characteristics and complications of difficult pediatric ...

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EM Physician Echo Assessment of Hypotensive Patients

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The Article:

Moore CL, Rose GA, Kline JA et al. “Determination of Left Ventricular Function by Emergency Physician Echocardiography of Hypotensive Patients” Academic Emergency Medicine Journal.  9(2002): 186-193

The Idea:

Systemic hypotension is a common and life threatening emergency. Differentiation of shock determines diagnosis and treatment. Can Emergency Physicians (EP) trained in cardiac ultrasound accurately assess left ventricular function in hypotensive ED patients?

The Study:

Prospective Study: 51 Patients presenting to ED with symptomatic hypotension were enrolled and evaluated by bedside Echo by 4 different ...

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Effects of Tranexamic Acid on Bleeding Trauma Patients

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The Article:

“Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant hemorrhage (CRASH-2):  a randomised, placebo-controlled trial.” Lancet.  2010; 376: 23-32.

The Idea:

Hemorrhage is responsible for approximately one third of in-hospital trauma deaths.  The study aimed to assess how administration of tranexamic acid (TXA) in trauma patients at risk of significant bleeding (HR >110, SBP <90) effected death, vascular occlusive events, and the receipt of blood transfusion.

The Study:

Randomized controlled trial from 274 hospitals in ...

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Rib Fracture Diagnosis in the Panscan Era

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The Article:

Rib Fracture Diagnosis in the Panscan Era. Murphy et al. (2017) Annals of Emergency Medicine. 70:1-6.

The Idea:

To determine if rib fractures missed on x-ray but picked up on CT have the same clinical significance as those diagnosed by x-ray.

The Study:

A planned secondary analysis of data from 2 prospective observational studies of blunt trauma patients over age 14 who had both chest x-ray (CXR) and chest CT in the ED as part of their trauma work-up. Primary outcomes were the ...

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