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We hope the Academic Half Day talks really got you thinking and will influence how you manage your patients in the future! For those present in person and by zoom, we thank you! A special thanks our guest lecturers who took the time to teach us some key points to keep in mind in the ED! 

For those of you who were not able to attend, we hope to see you next time! 😊

Here are the key takeaways from the presentations of the day: 

Approach to Urticaria, Angioedema, and Mast Cell Activation Syndrome for the Emergency MD – Dr. Michael Fein

1. History is key: characterize angioedema as histamine-mediated or bradykinin-mediated and hives as acute or chronic
2. Check for ACE-I, NSAID, Estrogen use
3. In acute angioedema, check a C4 level
4. In acute anaphylaxis, check a tryptase level and document time from reaction 
5. Treatment: Acute urticaria/angioedema can be treated with up to 4x doses of second-generation antihistamines
6. Any concern for anaphylaxis… EPI

Saving the Heart at the Expense of the Brain: Finding an Upper Limit of Epinephrine use in Cardiac Arrest – Dr. Thuy-An Mai-Vo

1. Epinephrine in cardiac arrest has unclear survival benefit. While it increases chance of ROSC, it may have potential harmful effects in the post-resuscitation phase
2. Increasing doses of epinephrine is associated with increased mortality and unfavourable neurological outcomes
3. Greater than 7 doses of epinephrine can be considered futile

A few tips about CHF – Dr. Mark Liszkowski

1. Recognize the High Mortality Rate of CHF and Act Urgently
   • CHF has a high mortality rate similar to STEMI, necessitating immediate and effective treatment in the ER.
2. Utilize ntBNP for Diagnosis, Monitoring, and Risk Prediction
   • Regular measurement of ntBNP helps in diagnosing CHF, assessing treatment response, and predicting the risk of rehospitalization.
3. Normalize Congestion (CVP and Filling Pressures)
   • Persistent congestion and elevated CVP increase the risk of rehospitalization and adverse outcomes; normalizing these pressures is crucial.
4. Implement a Comprehensive Management Approach
   • Diuretics alone are insufficient; a multifaceted approach including GDMT and cardiology/CHF referral are essential for effective management of ADCHF.
5. Understand the Role of Furosemide in Renal Function
   • Furosemide can improve renal function in CHF patients by reducing congestion, contrary to the myth that it is harmful to the kidneys.

Journal club: Andexanet for Factor Xa Inhibitor Associated Acute Intracerebral Hemorrhage – Drs. Harrish Gangatharan and Harmine C. Leo

1. Reduction in hematoma expansion but no clear improvement in clinically important outcomes
2. ANNEXA-I did not find a strong benefit of Andexanet Alfa over usual care except for 2 specific points
3. Andexanet Alfa is associated with a significant increase in thrombotic events including stroke
   Written Summary

What is Better to Diagnose Acute Aortic Syndrome? Clinical Judgement or Clinical Decision Tools – Dr. Humaid Alkhateri

1. The clinical tools are not ready yet for the prime time. 
2. There is no easy solution for AAS, if you suspect it get CT scan. 

Cardinal Topic: GI Bleeds – Dr. Bader Ali

1. UGIB and LGIB are usually distinguished based on history and physical exam 
2. In UGIB distinguish if likely variceal or non-variceal source based on history and exam
3. Manage unstable UGIB with blood transfusion, Antibiotics, PPI, Vasoconstrictive and prokinetic medications though patient will ultimately require urgent endoscopy. 
4. LGIB are usually either managed by colonoscopy or IR angiography/embolization
5. Always think of Aorto-enteric fistula in a patient presenting with GI bleed with a history of AAA repair