COMMENTARY

The Most Life-Saving Emergency Medicine Articles of 2014

Amal Mattu, MD

Disclosures

December 19, 2014

Introduction

The past year has once again been an outstanding one for emergency medicine (EM) research. When I solicited my colleagues for their opinions on the best and most useful journal publications of the year, I received more than three dozen selections to consider, ranging from topics on deadly conditions such as sepsis and cardiac arrest to more benign everyday conditions such as pharyngitis and corneal abrasions.

Although I found all of the articles to be useful, I had to narrow my selections. I'll make the usual disclaimer that these are not necessarily the best articles from a methodological standpoint, but they are practice-changing and focus on high-risk conditions where lives are at stake.

These are the guidelines, reviews, and research articles from 2014 that I believe will help save lives. My summaries will be brief, and I encourage readers to seek further details from the articles themselves.

New Guidelines on NSTE-ACS Management

2014 AHA/ACC Guideline for the Management of Patients With Non-ST-elevation Acute Coronary Syndromes: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Amsterdam EA, Wenger NK, Brindis RG, et al
Circulation. 2014 Sep 23. [Epub ahead of print]

Last year we reviewed the 2013 American Heart Association/American College of Cardiology (AHA/ACC) guidelines on management of ST-segment elevation myocardial infarction. Late in 2014 the AHA/ACC published their newest guidelines on management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The document is too large to summarize here, but there is one section that must be highlighted for acute care providers: the recommendations for urgent catheterization.

Patients with NSTE-ACS who require an "urgent/immediate invasive strategy" include the following: patients with refractory angina despite aggressive use of standard antianginal medications; patients with evidence of evolving heart failure or worsening mitral regurgitation; patients with hemodynamic instability; and patients with sustained ventricular tachycardia or ventricular fibrillation (excepting patients with serious comorbidities or contraindications to such procedures). These have been given a Class I indication, level of evidence A, for invasive therapy within 2 hours. Note that immediate catheterization is now indicated for patients who are post-ventricular fibrillation cardiac arrest even in the absence of ST-segment elevation on the ECG.

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