Critical pathways in cardiology
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Comparative Study
Emergency Department greeters reduce door-to-ECG time.
Screening for Acute Coronary Syndrome in chest pain patients can be initiated with a 12-lead electrocardiogram (ECG). Current American College of Cardiology/American Heart Association guidelines recommends getting an ECG performed and reviewed within 10 minutes of the time these patients present to the Emergency Department (ED). One innovative method to improve door-to-ECG time is by placing a trained greeter in the triage section of the ED. ⋯ ED triage greeter can be effectively used to obtain timely ECGs in suspected Acute Coronary Syndrome patients.
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Clinical Trial
Evaluation of proton pump inhibitor use in patients with acute coronary syndromes based on risk factors for gastrointestinal bleed.
Use of proton pump inhibitor (PPI) reduces the risk of gastrointestinal (GI) bleeding, and is generally recommended for high GI risk patients taking nonsteroidal anti-inflammatory agents. Aspirin and/or anticoagulants have been identified as increasing the risk of GI bleeding, whereby use of PPI could reduce this risk. The use of PPI in routine practice is not well defined, especially in patients with acute coronary syndromes (ACS) who require one or several antithrombotic drugs. ⋯ Use of PPI following ACS is modest, although it did increase with an increasing number of previously identified GI risk factors. Further, larger studies are warranted to validate prior, or identify new, risk factors as predictors of long-term bleeding, and improve awareness of GI bleeding risk such that use of PPI could be optimized.
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Risk of acute coronary events in patients with methamphetamine and cocaine intoxication has been described. Little is known about the need for additional evaluation in these patients who do not have evidence of myocardial infarction after the initial emergency department evaluation. We herein describe our experience with these patients in a chest pain unit (CPU) and the rate of cardiac-related chest pain in this group. ⋯ These findings suggest a relatively high rate of CAD in patients with methamphetamine and cocaine use evaluated in a CPU.