Code EM - Emergency Medicine Education / Medical Update

Code EM - Emergency Medicine Education / Medical Update

2/23/2025, 12:34:27 PM

Initial Testing Bundle: - Order HBsAg, anti-HBc, and anti-HBs Then follow the HBsAg result: *1. If HBsAg is Positive* : - Order IgM anti-HBc - If IgM anti-HBc is positive → _Acute HBV Infection_ - If IgM anti-HBc is negative → _Chronic HBV Infection_ - For chronic infection, order additional tests: * HBeAg * HBV DNA * LFTs (Liver Function Tests) * Liver fibrosis assessment *2. If HBsAg is Negative:* Check anti-HBc status: A. If anti-HBc is Positive: - Check anti-HBs - If anti-HBs positive → _Resolved HBV Infection_ - If anti-HBs negative → _Four possible interpretations:_ 1. _Resolved infection_ 2. _False positive anti-HBc_ 3. _'Low level' chronic infection_ 4. _Window period_ B. If anti-HBc is Negative: - Check anti-HBs - If anti-HBs positive → _Immune due to vaccination_ - If anti-HBs negative → _Susceptible (candidate for vaccination)_ This systematic approach helps determine the patient's Hepatitis B status and appropriate next steps in management.

Code EM - Emergency Medicine Education / Medical Update

2/14/2025, 12:07:39 PM

Would like to suggest a nice you tube channel for EBM fans here https://youtube.com/@first10em?si=YLzHDJtlCGNQ7QmS Evidence based medicine is the perk of modern medicine this channel is nice in giving you monthly update as BroomeDocs podcast https://youtu.be/nVxgLZv7xIw?si=Bo-4UuaH17V5adi1 Occasion discussion on clinical scenarios Link to few of my favorite discussion Status epilepsy https://youtu.be/wmbF9wH678s?si=XBdrxaVezmwcrBun SVT https://youtu.be/HHwguwoqzjY?si=yEHKR9-x4EinZdnv RSI vs DSI https://youtu.be/5g4cV1JaIZQ?si=aaW8pEkHT7pqD7mY

Code EM - Emergency Medicine Education / Medical Update

2/20/2025, 11:57:16 AM

*New Scientific Statement from AHA: Management of Elevated Blood Pressure in Acute Care Settings* ⁠ *Hypertensive Emergency:* SBP/DBP >180/110-120 mmHg + target-organ damage *Asymptomatic Markedly Elevated BP:* SBP/DBP >180/110-120 mmHg (formerly "hypertensive Urgency") with out end-organ damage *Asymptomatic Elevated BP:* SBP/DBP ≥130/80 mmHg No more recommendation for previous terms ❌ *Hypertensive criss* SBP/DBP > 180/110 irrespective of end-organ status ❌ *Accelerated hypertension* - SBP/DBP > 180/110 with neuroretinal - hemorrhagic spots or exudate in fundoscopy ❌ *Malignant hypertension* - SBP/DBP > 180/110 with papillary edema in fundoscopy ❌ *Hypertensive Urgency* 🔁 *Asymptomatic Markedly Elevated BP* ✅ 🆕 *Asymptomatic Elevated BP* ✅

Code EM - Emergency Medicine Education / Medical Update

2/12/2025, 12:57:58 PM

*Cardiogenic shock may be roughly conceptualized as requiring two components:* (1) Systemic hypoperfusion due to low cardiac output (cold).❄️ (2) Filling pressures are elevated due to fluid overload (wet)💧 🥲Giving volume will worsen their pulmonary congestion (making them wetter). 🥲Removing volume will worsen their systemic hypoperfusion (making them colder). Management of cardiogenic shock usually requires interventions to improve cardiac function (e.g., inotropic medications, revascularization, or a mechanical support). Cardiogenic shock patients may look deceptively OK, but they are indeed critically ill. Early recognition facilitates appropriate ICU management. The patient with unrecognized cardiogenic shock will generally fail to respond to non-intensive therapy, running in circles (typically the patient is initially diuresed, then develops worsening renal failure, then is given fluid back, then develops pulmonary edema, then transferred to ICU). https://emcrit.org/ibcc/chf/#bedside_hemodynamic_assessment

Code EM - Emergency Medicine Education / Medical Update

2/8/2025, 4:46:20 PM

Dose of hydrocortisone in sepsis shock Inj Hydrocortisone 50mg IV Q6h

Code EM - Emergency Medicine Education / Medical Update

2/10/2025, 4:24:06 PM

WOBBLER for ECG assessment in Syncope🤓 *W - Wolff Parkinson White* https://litfl.com/pre-excitation-syndromes-ecg-library/ *O - Obstructed AV pathway* https://litfl.com/av-block-3rd-degree-complete-heart-block/ *B - Bifascicular block* https://litfl.com/bifascicular-block-ecg-library/ *B - Brugada* https://litfl.com/brugada-syndrome-ecg-library/ *L - Left ventricular Hypertrophy* (consider AS, HOCM) https://litfl.com/left-ventricular-hypertrophy-lvh-ecg-library/ *E - Epsilon wave* https://litfl.com/epsilon-wave-ecg-library/ *R - Repolarisation abnormality* https://litfl.com/qt-interval-ecg-library/ ECG work up in Syncope https://youtu.be/CQ8AE7Nt1W8?si=1WxE2TdB-IpBIMg7

Code EM - Emergency Medicine Education / Medical Update

2/20/2025, 12:07:12 PM

Scientific Statement AHA: Management of Elevated Blood Pressure in Acute Care Settings https://www.ahajournals.org/doi/10.1161/HYP.0000000000000238 *1. Background and Context* - Elevated blood pressure (BP) affects up to 72% of hospital admissions. - Hypertensive emergencies require immediate treatment with intravenous (IV) antihypertensives. - Asymptomatic elevated BP is common, but treatment risks and benefits are unclear. *2. Definitions* - *Hypertensive Emergency*: BP >180/110–120 mmHg with acute target-organ damage. - *Asymptomatic Markedly Elevated BP*: BP >180/110–120 mmHg without target-organ damage. - *Asymptomatic Elevated BP*: BP ≥130/80 mmHg without target-organ damage. *3. Epidemiology* - Hypertensive emergencies account for 2 in 1,000 adult ED visits. - Asymptomatic elevated BP affects 50–72% of hospitalizations, with higher prevalence in older adults, Black individuals, and those with comorbidities. *4. BP Measurement in Acute Care* - BP measurement is often inconsistent and prone to errors. - Arterial lines are preferred for hypertensive emergencies. *5. Management of Elevated BP* - *Hypertensive Emergency*: Treat with IV antihypertensives to reduce BP by 20–25% within the first hour. - *Asymptomatic Elevated BP*: Treatment is less clear; avoid aggressive treatment, especially with IV medications. *6. Evidence Gaps and Research Priorities* - No randomized trials on treating asymptomatic elevated BP in acute care settings. - Future research should focus on defining optimal BP targets, improving BP measurement practices, and evaluating treatment benefits and risks. *7. Transitions of Care* - Focus on restarting home antihypertensive medications, scheduling timely follow-up, and avoiding unnecessary intensification of antihypertensive regimens. *8. Health Equity Considerations* - Disparities in hypertension management persist, particularly among underinsured, low-income, and minority populations. *9. Key Clinical Implications* - Use proper BP measurement techniques and calibrated devices. - Avoid unnecessary treatment of asymptomatic elevated BP. - Focus on addressing reversible causes of elevated BP. Conclusion The management of asymptomatic elevated BP in acute care settings should be cautious and patient-centered. Overtreatment may lead to harm. Future research is needed to clarify optimal treatment strategies and BP targets. https://youtu.be/kJ-bRaV00XU?si=Yw3cmqTuugh-OJP7