What’s New in April for Emergency Medicine features: Beta Blockers in Acute Myocardial Infarction, Diagnosis of Acute Pancreatitis, Timing of CT Scan in Suspected CNS Infection

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Unstable Angina and Non-St Segment Elevation Acute Coronary Syndrome

ANDRA L. BLOMKALNS, MD

University of Texas Southwestern, Dallas, TX

 

Beta Blockers in Acute Myocardial Infarction

Beta blockers remain underused in clinical practice despite demonstrated efficacy in acute myocardial infarction (AMI). They have been shown to reduce myocardial oxygen demand and infarction size, and alleviate AMI-related pain. They also reduce the likelihood of developing mechanical and arrhythmogenic complications of AMI. They can be dosed in a wide range, and should be started at the lower end of the dosing range and titrated upward. The only relative contraindications to treatment with beta blockers are mild to moderate heart failure, obstructive airway disease (in the absence of asthma), peripheral vascular disease, diabetes mellitus and a history of cardiomyopathy.

 


 

 

Acute Pancreatitis

JASON AHN, MD, MPA

Emergency Medicine, Harvard Medical School, Boston, MA

CALVIN K. HUANG, MD, MPH,

Emergency Medicine, Harvard Medical School, Boston, MA

 

Diagnosis of Acute Pancreatitis

The chief presenting complaint in acute pancreatitis is abdominal pain. The differential diagnosis for pancreatitis is broad, and includes abdominal, pulmonary, urologic and cardiovascular pathologies. Recent guidelines state that the diagnosis of acute pancreatitis should be established by meeting two of the following clinical, laboratory, or imaging criteria: abdominal pain and examination consistent with the disease, a serum amylase and/or lipase three times the upper limit of normal, and/or computed tomography, magnetic resonance imaging, or ultrasonography findings consistent with the disease.

 


 

 

Central Nervous System Infections

NICHOLAS J. JOHNSON, MD

Critical Care Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA

DAVID F. GAIESKI, MD

Emergency Medicine, Resuscitative Services, Emergency Critical Care, Thomas Jefferson University, Philadelphia, PA

 

Timing of CT Scan in Suspected CNS Infection

Controversy exists about whether to obtain a computed tomography (CT) scan prior to lumbar puncture in patients with suspected central nervous system (CNS) infection, with the aim of identifying conditions that may result in cerebral herniation if lumbar puncture is performed. Current recommendations state that adult patients should receive CT prior to lumbar puncture if they are immunocompromised, have a history of CNS disease, presence of new-onset seizure, papilledema, an abnormal level of consciousness, and/or a focal neurologic deficit.

 


As seen in Scientific AmericanTM Emergency Medicine.