Does the Electrocardiogram Machine Interpretation Affect the Ability to Accurately Diagnose ST-Elevation Myocardial Infarction by Emergency Physicians?

INTRODUCTION: An ST-elevation myocardial infarction (STEMI) can portend significant morbidity and mortality to the patient and therefore must be rapidly diagnosed by an emergency medicine (EM) physician. The primary aim of this study is to determine whether EM physicians are more or less likely to accurately diagnose STEMI on an electrocardiogram (ECG) if they are blinded to the ECG machine interpretation as opposed to if they are provided the ECG machine interpretation. METHODS: We performed a retrospective chart review of adult patients over 18 years of age admitted to our large, urban tertiary care center with a diagnosis of STEMI from January 1, 2016, to December 31, 2017. From these patients' charts, we selected 31 ECGs to create a quiz that was presented twice to a group of emergency physicians. The first quiz contained the 31 ECGs without the computer interpretations revealed. The second quiz, presented to the same physicians 2 weeks later, contained the same set of ECGs with the computer interpretations revealed. Physicians were asked "Based on the ECG above, is there a blocked coronary artery present causing a STEMI?" RESULTS: Twenty-five EM physicians completed two 31-question ECG quizzes for a total of 1550 ECG interpretations. On the first quiz with computer interpretations blinded, the overall sensitivity in identifying a "true STEMI" was 67.2% with an overall accuracy of 65.6%. On the second quiz in which the ECG machine interpretation was revealed, the overall sensitivity was 66.4% with an accuracy of 65.8 % in correctly identifying a STEMI. The differences in sensitivity and accuracy were not statistically significant. CONCLUSION: This study demonstrated no significant difference in physicians blinded versus those unblinded to computer interpretations of possible STEMI.

Emergency department management of acute asthma exacerbations.

Asthma is a disease of the airways characterized by inflammation, hyperresponsiveness, and bronchoconstriction. The diagnosis is primarily a clinical one, based on a focused history and physical examination, to differentiate from other entities such as heart failure, pneumonia, and pulmonary embolism. Radiographs, laboratory studies, and blood gases are not routinely recommended, except in atypical or refractory cases, or if there is diagnostic uncertainty. The cornerstone of acute asthma treatment includes short-acting beta agonists, anticholinergics, and systemic corticosteroids. This issue reviews the latest evidence in diagnostic and treatment strategies, including other pharmacologic treatments and newer management strategies to avoid intubation.

Synthesis and electronic characterization of bipyridine dithiolate rhodium(III) complexes.

Five new mixed diimine 1,1'-dithiolate or dithiocarbamate ligand complexes of the form [Rh(bpy)2(SS)][PF6]n, where bpy = 2,2'-bipyridine and SS = various substituted dialkyldithiocarbamates or 1,1'-dithiolates, were synthesized from cis-[Rh(bpy)2(OTf)2][OTf]. The triflate ligands are easily displaced by other ligands and allow these syntheses to proceed in high yields (80-90% overall) under relatively mild reaction conditions and to give high purity products. Electrochemistry shows irreversible two-electron reduction of Rh(III) to Rh(I) and a concomitant loss of one bipyridine ligand; this is followed by reversible one-electron reduction of the remaining 2,2'-bipyridine ligand. The electronic characterizations of these complexes are consistent with significant delocalization of the sulfur electron density onto the empty metal d orbitals. The 1,1'-dithiolate ligands induce larger red shifts in the absorption and emission spectra than the dithiocarbamates as the 1,1'-dithiolates have a more extensive conjugation system.