August 10, 2007

CRUSADE: Contemporary Evaluation and Management Of 200,000 High-Risk NSTE-ACS Patients

August 10, 2007/ EMCREG-International

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).

August 01, 2007

Diagnosis and Risk Stratification of Acute Heart Failure Syndromes

August 01, 2007/ EMCREG-International

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.

June 20, 2007

Pulmonary Embolism and Deep Venous Thrombosis: Evaluation and Treatment in the Emergency Department

June 20, 2007/ EMCREG-International

Venous thromboembolism (VTE) is a clinical entity which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). VTE is a common medical condition affecting up to 117 patients per 100,000 population annually.1 The diagnosis of VTE is often difficult and frequently missed. Mortality in untreated PE is approximately 30%, but with adequate anticoagulant treatment, this can be reduced to 2–8%. The purpose of this Newsletter is to focus on the diagnosis and treatment of VTE, including PE and DVT in the emergency department (ED). In this EMCREG-International Newsletter, Dr. Charles Cairns, Associate Professor of Surgery and Medicine and Associate Chief of Emergency Medicine at the Duke University School of Medicine discusses the important disease process venous thromboembolism (VTE) which includes deep venous thrombosis and pulmonary embolism from the perspective of emergency medicine.

March 08, 2007

Direct Thrombin Inhibitors in Non-ST-Segment Elevation Acute Coronary Syndromes

March 08, 2007/ EMCREG-International

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.

January 05, 2007

ST-Segment Elevation Myocardial Infarction: Decreasing The Time To Treatment In The Emergency Department

January 05, 2007/ EMCREG-International

Patients presenting to the Emergency Department (ED) with ST-segment elevation acute myocardial infarction (STEMI) require rapid diagnosis and treatment to optimize their outcome. Early diagnosis is accomplished by acquiring a 12-lead electrocardiogram within 10 minutes after ED presentation to identify STEMI and then begin treatment. Most irreversible myocardial damage occurs within the first 3 hours after symptom onset so delivery of fibrinolytic therapy or mechanical opening of the coronary artery using percutaneous coronary intervention (PCI) must be initiated early after presentation to the hospital to achieve greatest benefit.

December 15, 2006

Advancing the Standard of Care - Cardiovascular and Neurovascular Emergencies (2006)

December 15, 2006/ EMCREG-International

EMCREG–International is pleased to present this complimentary 84-page CME monograph covering the proceedings of our satellite symposium at the ACEP Scientific Assembly in New Orleans, Louisiana. A number of important topics are covered in this monograph including management of non-ST-segment elevation and ST-segment elevation acute coronary syndrome (ACS), the CRUSADE Quality Improvement Initiative, decreasing time to treatment for ST-segment elevation myocardial infarction, direct thrombin inhibitors in ACS, acute decompensated heart failure care, the use of lactate as a marker for trauma and sepsis, point-of-care testing for cardiac biomarkers, the management of hypertension in acute neurovascular emergencies and advances in acute stroke care.

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