SICK OR NOT SICK? : EVOLVING BIOMARKERS FOR SEVERE BACTERIAL INFECTION

SICK OR NOT SICK? : EVOLVING BIOMARKERS FOR SEVERE BACTERIAL INFECTION

In the United States, sepsis accounts for over 751,000 cases, 215,000 deaths, and 16.7 billion dollars in health care costs annually. Severe sepsis kills more individuals than breast, colon, rectal, pancreatic, and prostate cancer combined. With the difficulties associated with access to primary care and more aggressive emphasis on rapid hospital discharge and outpatient surgeries, sepsis ranks as one of the highest prevalence, highest mortality, and most expensive conditions that an emergency physician will encounter.

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RISK STRATIFICATION FOR PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN THE EMERGENCY DEPARTMENT

RISK STRATIFICATION FOR PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN THE EMERGENCY DEPARTMENT

Unstable angina (UA) and non-ST-segment elevation myocardial infarction (NSTEMI) accounted for 1,295,000 hospital admissions in the US in 2001, almost 60% of those patients were 65 years of age or older, and 41% were women. The National Center for Health Statistics recently reported 5,637,000 US emergency department (ED) chest-pain syndrome visits, accounting for approximately 5% of total visits. Accurate diagnosis and risk stratification of the UA/NSTEMI patient is essential to identify patients at risk and to initiate appropriate treatment.

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USE OF DIRECT THROMBIN INHIBITORS FOR TREATING NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN SPECIAL PATIENT GROUPS: WOMEN, DIABETICS, THE ELDERLY, AND CHRONIC RENAL INSUFFICIENCY

USE OF DIRECT THROMBIN INHIBITORS FOR TREATING NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES IN SPECIAL PATIENT GROUPS: WOMEN, DIABETICS, THE ELDERLY, AND CHRONIC RENAL INSUFFICIENCY

This complimentary newsletter provides a targeted review of the results of the ACUITY trial with particular emphasis on the high risk populations - women, elderly, diabetics, and patients with chronic renal insufficiency. In addition, he describes the findings of ACUITY in relation to therapy "switch", when patients were initially treated with heparins prior to randomization. Emergency physicians are increasingly becoming exposed to a greater variety of therapies for patients with acute coronary syndrome. It is our hope to provide you, the practicing clinician, with the educational tools to continue to give outstanding care to your patients.

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CRUSADE: CONTEMPORARY EVALUATION AND MANAGEMENT OF 200,000 HIGH-RISK NSTE-ACS PATIENTS

CRUSADE: CONTEMPORARY EVALUATION AND MANAGEMENT OF 200,000 HIGH-RISK NSTE-ACS PATIENTS

After six years and the enrollment of over 200,000 patients, the CRUSADE national quality improvement and educational initiative ended on January 31, 2007. This date brought to a close an invaluable and unprecedented compilation of data on the management of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS), as well as important data on a smaller but very contemporary cohort of patients with acute ST-segment elevation myocardial infarction (STEMI).

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DIAGNOSIS AND RISK STRATIFICATION OF ACUTE HEART FAILURE SYNDROMES

DIAGNOSIS AND RISK STRATIFICATION OF ACUTE HEART FAILURE SYNDROMES

The evaluation and management of emergency department patients with potential acute heart failure syndrome have remained a significant challenge for decades. Dramatically, unlike advances for the assessment and treatment of patients with acute coronary syndrome, the emergency physician’s diagnostic tools for heart failure have remained limited. The complexity and morbidity of this syndrome alone has led to risk aversion and extremely high admission rates. These difficulties, as well as the increasing prevalence and incidence of heart failure due to improved treatment of ACS and our aging population, has placed an enormous burden on healthcare resources worldwide.

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DIRECT THROMBIN INHIBITORS IN NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES

DIRECT THROMBIN INHIBITORS IN NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROMES

For patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) presenting to the emergency department, appropriate anti-thrombotic and anti-platelet therapy is critical to optimize outcome. Unfractionated heparin is often given as an anti-thrombin in this setting, however, if suffers from a number of pharmacologic limitations including non-specific binding, the requirement for frequent monitoring of its anti-coagulant effect, and the formation of antibodies to the heparin/platelet factor 4/platelet complex which can cause heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia thrombosis syndrome (HITTS). Low molecular weight heparins, also an indirect thrombin inhibitor, can be used without monitoring their anti-thrombin effects. Ease of use and effectiveness makes them a popular choice in the emergency setting.

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