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The Things We Carry

The ID, the pen, the epinephrine, the scalpel are the nonnegotiables, the necessities for any hospital shift. But they are not the only things a physician carries, and certainly not the most burdensome.

Sudden Cardiac Arrest in Athletes

Sudden cardiac arrest in athletes may be attributable to cardiac and noncardiac causes. With diagnosis and treatment, a return to play may be reasonable. Prevention, emergency planning, and shared decision making are key.

Pneumocystis jirovecii Pneumonia

A 60-year-old man with recently diagnosed HIV infection presented with a 10-day history of fever, dry cough, and shortness of breath. A CT scan of the chest showed diffuse nodules and ground-glass opacities.

LVAD

When a man ends up in the ED after having severed the driveline of his left ventricular assist device, the medical student on his team learns that sometimes a life saved is not the life the patient wants to live.

The Eyes Have It

A 47-year-old man was brought to the ED by EMS after being found dyspneic in his car. He reported having been drinking for 6 hours before presentation. He noted a sensation of tongue swelling and difficulty breathing.

Seeing It Through — Lessons from a Retinal Stroke Trial

The retina is a specialized patch of central nervous system tissue located at the back of the eye. When the principal source of oxygen and metabolic substrates to the retina — the central retinal artery — is occluded, rapid retinal cell death and loss of visual function ensue. This acute… The retina is a specialized patch of central nervous system tissue located at the back of the eye. When the principal source of oxygen and metabolic substrates to the retina — the central retinal artery — is occluded, rapid retinal cell death and loss of visual function ensue. This acute…

A Randomized Trial of Tenecteplase in Acute Central Retinal Artery Occlusion

In acute central retinal artery occlusion treated within 4.5 hours after onset, intravenous tenecteplase did not result in greater recovery of vision at 30 days than aspirin and was associated with serious safety concerns.

Secondary Prevention after Ischemic Stroke

After ischemic stroke, recurrence risk is reduced by identifying the stroke mechanism and targeting modifiable risk factors. Early diagnostic evaluation, prompt preventive therapy, and ongoing monitoring are central to care.

Fremanezumab in Children and Adolescents with Episodic Migraine

In children and adolescents with episodic migraine, fremanezumab led to a greater reduction in migraine days per month than placebo (−2.5 days vs. −1.4), and nearly half of recipients had a reduction of 50% or more in migraine days.

Managing Asymptomatic Carotid Stenosis

The management of carotid-artery stenosis that has not caused recent symptoms — asymptomatic carotid stenosis — has been controversial. Clinical trials that began more than 30 years ago showed a small benefit of carotid endarterectomy as compared with medical treatment, but improvements in medical prevention of stroke call into question… The management of carotid-artery stenosis that has not caused recent symptoms — asymptomatic carotid stenosis — has been controversial. Clinical trials that began more than 30 years ago showed a small benefit of carotid endarterectomy as compared with medical treatment, but improvements in medical prevention of stroke call into question…