Discover and read the best of Twitter Threads about #acep21
Most recents (3)
Bloody Hell: GI Bleed Management in the ED at #ACEP21 
Upper vs Lower GIB at #ACEP21
Low BP = Assume UGIB
BRBPR w/Clots = LGIB
BUN/Cr >30 = UGIB
NGL = NOT Helpful
Low BP = Assume UGIB
BRBPR w/Clots = LGIB
BUN/Cr >30 = UGIB
NGL = NOT Helpful
EVEN GI guidelines don't support NGL #ACEP21
The American College of Gastroenterology 2012 guidelines state NGL is not required in pts with UGIB for diagnosis, prognosis, visualization, or therapeutic effect
The American College of Gastroenterology 2012 guidelines state NGL is not required in pts with UGIB for diagnosis, prognosis, visualization, or therapeutic effect
Cruising the Literature: Updates in GI Emergencies at #ACEP21
-CODA: Abx 1st vs Surgery 1st for Appendicitis
-HALT-IT: TXA for GIBs
-Timing of Endoscopy in GIBs
-Topical Capsaicin Cream for Cannaboid Hyperemesis
-Inhaled Isopropyl Alcohol for N/V
-CODA: Abx 1st vs Surgery 1st for Appendicitis
-HALT-IT: TXA for GIBs
-Timing of Endoscopy in GIBs
-Topical Capsaicin Cream for Cannaboid Hyperemesis
-Inhaled Isopropyl Alcohol for N/V
CODA: Abx 1st vs Surgery 1st for Appendicitis
rebelem.com/rebel-cast-ep-…
-Abx non-inferior to surgery BUT...
-Appendectomy in 30% by 90d
-3x more ED visits
-2x more complications
-Appendicoliths higher risk for complications
rebelem.com/rebel-cast-ep-…
-Abx non-inferior to surgery BUT...
-Appendectomy in 30% by 90d
-3x more ED visits
-2x more complications
-Appendicoliths higher risk for complications
HALT-IT: TXA for GIBs
rebelem.com/rebel-cast-ep8…
-No Benefit
-Increased Harms
-Timing of GIB Difficult
rebelem.com/rebel-cast-ep8…
-No Benefit
-Increased Harms
-Timing of GIB Difficult
ECG Indications for Emergent Reperfusion via @amalmattu at #ACEP21
Concerning Symptoms PLUS...
-STE in Contiguous Leads
-Posterior STEMI
-Non STE-ACS WITH...
-Refractory Ischemia
-Developing Acute Heart Failure
-Electrical Instability
-HD Instability
Concerning Symptoms PLUS...
-STE in Contiguous Leads
-Posterior STEMI
-Non STE-ACS WITH...
-Refractory Ischemia
-Developing Acute Heart Failure
-Electrical Instability
-HD Instability
Additionally, Increasing Lit BUT NOT YET in the US Guidelines...
-LBBB w/Sgarbossa Criteria(& Modified)
-Pacers w/Sgarbossa Criteria(& Modified)
-de Winter T-Waves
-STE aVR w/Diffuse STD
Serial ECGs if you see...
-Hyperacute Ts in Symptomatic Pts
-STD in aVL in Symptomatic Pts
-LBBB w/Sgarbossa Criteria(& Modified)
-Pacers w/Sgarbossa Criteria(& Modified)
-de Winter T-Waves
-STE aVR w/Diffuse STD
Serial ECGs if you see...
-Hyperacute Ts in Symptomatic Pts
-STD in aVL in Symptomatic Pts
Sgarbossa & Modified Criteria
A = Concordant STE ≥1mm in any lead
B = Concordant STD ≥ 1mm in V1, V2, or V3
C = Discordant STE ≥5mm (Less Specific)
Modified = ST Deviation > 25% of size of S Wave
A = Concordant STE ≥1mm in any lead
B = Concordant STD ≥ 1mm in V1, V2, or V3
C = Discordant STE ≥5mm (Less Specific)
Modified = ST Deviation > 25% of size of S Wave
