The 2018 calendar year was once again rife with outstanding additions to the emergency medicine literature from numerous journals in many specialties. In selecting this year's three "must-read" articles, I focused on what I believe is practice-changing and once again chose to avoid articles that I've covered in prior Viewpoints.
These are excellent reads with take-home points that go beyond my simple summaries. I hope all acute care physicians will take some time to read them. Until then, enjoy these synopses.
Clinical Policy: Critical Issues in the Evaluation and Management of ED Patients With Suspected Non-ST-elevation Acute Coronary Syndrome
The evaluation of patients with potential acute coronary syndrome (ACS) has been the bane of emergency medicine for decades. For many years, we have been overadmitting patients for potential ACS, leading to costly negative workups. A major reason for the excessively conservative approach to these patients has been fear of litigation in the event that we miss ACS. Litigation would often be based on failure to follow guidelines, which have, for many years, stated that all of these patients need to receive a provocative test after being ruled out for myocardial infarction (MI).[1]The result is that an inordinate number of low-risk patients would be sent for provocative testing, which typically would also be negative.
