WikEM - User contributions [en]

EBQ:Sgarbossa Criteria Study

2014-04-22T21:22:16Z

Me7sn:

{{JC info
| title= Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators
| abbreviation= Sgarbossa Criteria
| expansion= Sgarbossa Criteria for diagnosing MI in presence of a LBBB
| published= 1996
| author= Sgarbossa E. et al.
| journal= NEJM
| year= 1996
| volume= 334
| issue=8
| pages= 481-7
| pmid= 8559200
| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199602223340801
| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM199602223340801
| status=Under Review
}}
==Clinical Question==
How can we diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]?

==Conclusion==
[[Sgarbossa's Criteria]] is a validated clinical prediction rule based on ECG criteria to diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]. It has good specificity, but poor sensitivity.

==Major Points==
'''The [[Sgarbossa Criteria]]:'''
# ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
# ST-segment depression in leads V1, V2 or V3 with a score of 3
# ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2
With a score >3 90% of those with positive criteria will have STEMI ('''Good Speciﬁcity''')
But with negative criteria it doesn't help that much ('''Low sensitivity''')

==Population==
===Patient Demographics===
* '''Median Age:''' 68 years
* '''Males:''' 64% in study group and 60% in experimental group
* '''Left Axis Deviation:''' 28% Vs. 48%
* '''Previous MI:''' 26% Vs. 59%

===Inclusion Criteria===
* '''Experiment''': Patients with [[LBBB]] and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref>
* '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref>

===Exclusion Criteria===
Patients without [[LBBB]]

==Outcomes==

===Primary Outcome===
[[Acute Myocardial Infarction]]

==Criticisms & Further Discussion==

==Funding==
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.

==Sources==
<references/>

[[Category:EBQ]]
[[Category:Cards]]

EBQ:Sgarbossa Criteria Study

2014-04-22T21:21:50Z

Me7sn:

{{JC info
| title= Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators
| abbreviation= Sgarbossa Criteria
| expansion= Sgarbossa Criteria for diagnosing MI in presence of a LBBB
| published= 1996
| author= Sgarbossa E. et al.
| journal= NEJM
| year= 1996
| volume= 334
| issue=8
| pages= 481-7
| pmid= 8559200
| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199602223340801
| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM199602223340801
| status=Under Review
}}
==Clinical Question==
How can we diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]?

==Conclusion==
[[Sgarbossa's Criteria]] is a validated clinical prediction rule based on ECG criteria to diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]. It has good specificity, but poor sensitivity.

==Major Points==
'''The [[Sgarbossa Criteria]]:'''
# ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
# ST-segment depression in leads V1, V2 or V3 with a score of 3
# ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2
With a score >3 90% of those with positive criteria will have STEMI ('''Good Speciﬁcity''')
But with negative criteria it doesn't help that much ('''Low sensitivity''')

==Population==
===Patient Demographics===
* '''Median Age:''' 68 years
* '''Males:''' 64% in study group and 60% in experimental group
* '''Left Axis Deviation:''' 28% Vs. 48%
* '''Previous MI:''' 26% Vs. 59%

===Inclusion Criteria===
* '''Experiment''': Patients with [[LBBB]] and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref>
* '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref>

===Exclusion Criteria===
Patients without [[LBBB]]

==Outcomes==

===Primary Outcome===
[[Acute Myocardial Infarction]]

===Subgroup analysis===

==Criticisms & Further Discussion==

==Funding==
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.

==Sources==
<references/>

[[Category:EBQ]]
[[Category:Cards]]

EBQ:Sgarbossa Criteria Study

2014-04-22T21:21:05Z

Me7sn:

{{JC info
| title= Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators
| abbreviation= Sgarbossa Criteria
| expansion= Sgarbossa Criteria for diagnosing MI in presence of a LBBB
| published= 1996
| author= Sgarbossa E. et al.
| journal= NEJM
| year= 1996
| volume= 334
| issue=8
| pages= 481-7
| pmid= 8559200
| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199602223340801
| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM199602223340801
| status=Under Review
}}
==Clinical Question==
How can we diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]?

==Conclusion==
[[Sgarbossa's Criteria]] is a validated clinical prediction rule based on ECG criteria to diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]. It has good specificity, but poor sensitivity.

==Major Points==
'''The [[Sgarbossa Criteria]]:'''
# ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
# ST-segment depression in leads V1, V2 or V3 with a score of 3
# ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2
With a score >3 90% of those with positive criteria will have STEMI ('''Good Speciﬁcity''')
But with negative criteria it doesn't help that much ('''Low sensitivity''')

==Study Design==

==Population==
===Patient Demographics===
* '''Median Age:''' 68 years
* '''Males:''' 64% in study group and 60% in experimental group
* '''Left Axis Deviation:''' 28% Vs. 48%
* '''Previous MI:''' 26% Vs. 59%

===Inclusion Criteria===
* '''Experiment''': Patients with [[LBBB]] and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref>
* '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref>

===Exclusion Criteria===
Patients without [[LBBB]]

==Outcomes==

===Primary Outcome===
[[Acute Myocardial Infarction]]

===Subgroup analysis===

==Criticisms & Further Discussion==

==Funding==
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.

==Sources==
<references/>

[[Category:EBQ]]
[[Category:Cards]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T20:45:46Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Conclusion==
* No Evidence supports its use for PH>6.9
* No studies done for PH<6.9
* American Diabetic Association Recommends giving 100 mmol NaHco3 in 400 Normal saline with 20 Meq potassium chloride over 2 hours<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

==Sources==
<references/>
[[Category:EBQ]]

==Helpful Links==
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T20:45:24Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Conclusion==
* No Evidence supports its use for PH>6.9
* No studies done for PH<6.9
* American Diabetic Association Recommends giving 100 mmol NaHco3 in 400 Normal saline with 20 Meq potassium chloride over 2 hours<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

==Sources==
<references/>
[[Category:EBQ]]

==Links==
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T20:43:35Z

Me7sn:

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T20:42:59Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Conclusion==
* No Evidence supports its use for PH>6.9
* No studies done for PH<6.9
* American Diabetic Association Recommends giving 100 mmol NaHco3 in 400 Normal saline with 20 Meq potassium chloride over 2 hours<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

==Links==

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T20:41:52Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Conclusion==
* No Evidence supports its use for PH>6.9
* No studies done for PH<6.9
* American Diabetic Association Recommends giving 100 mmol NaHco3 in 400 Normal saline with 20 Meq potassium chloride over 2 hours<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T20:41:11Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Conclusion==
No Evidence supports its use for PH>6.9
No studies done for PH<6.9
American Diabetic Association Recommends giving 100 mmol NaHco3 in 400 Normal saline with 20 Meq potassium chloride over 2 hours<ref>Diabetes Care July 2009 vol. 32 no. 7 1335-1343</ref>

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T18:38:01Z

Me7sn: /* Con Argument */

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Conclusion==
No Evidence supports its use for PH>6.9
No studies done for PH<6.9

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T00:15:57Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control<ref>Okuda Y, Adrogue HJ, Field JB, Nohara H, Yamashita K. Counterproductive effects of sodium bicarbonate in diabetic ketoacidosis. J Clin Endocrinol Metab. 1996 Jan;81(1):314-20. PubMed PMID: 8550770.</ref>

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T00:15:19Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level<ref>Hale PJ, Crase J, Nattrass M. Metabolic effects of bicarbonate in the treatment of diabetic ketoacidosis. Br Med J (Clin Res Ed). 1984 Oct 20;289(6451):1035-8. PubMed PMID: 6091840; PubMed Central PMCID: PMC1443021.</ref>

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-22T00:10:52Z

Me7sn: /* Con Argument */

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
16 patients in NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level

===Trial 8===
RCT of 7 Patients 3 of them received NaHco3 and showed delay ketones clearance for 6 hours compard with control

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-21T23:52:33Z

Me7sn: /* Con Argument */

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

===Trial 7===
RCT done for 38 patients
NaHco3 Group had delayed ketone clearance and no significant difference in blood glucose level

===Trial 8===

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-15T18:11:23Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation <ref>Chua HR, Schneider A, Bellomo R. Bicarbonate in diabetic ketoacidosis - a systematic review. Ann Intensive Care. 2011 Jul 6;1(1):23. doi: 10.1186/2110-5820-1-23. PubMed PMID: 21906367; PubMed Central PMCID: PMC3224469.</ref>

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-15T18:09:43Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group <ref>Green SM, Rothrock SG, Ho JD, Gallant RD, Borger R, Thomas TL, Zimmerman GJ. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998 Jan;31(1):41-8. Review. PubMed PMID: 9437340.</ref>

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224469/ <ref>Ann Intensive Care. 2011; 1: 23</ref>]

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-15T18:07:50Z

Me7sn:

==Clinical Question==
Should Sodium Bicarbonate be used to treat Diabetic Ketoacidosis ?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat DKA, but based on what ? Is there any evidence supporting its use ?

==Pro Argument==
Looking for any studies supporting its use ...

==Con Argument==
===Trial 1===
'''21 patients''' underwent RCT
* 10 patients (PH 6.9-7.14) received NaHco3
* 11 patients in the control group
'''Results:''' No differences in Glucose level, bicarb level nor PH <ref>Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986 Dec;105(6):836-40. PubMed PMID: 3096181</ref>

===Trial 2===
Prospective, Randomized, Blinded and cross over study included '''14 patients'''
* HCO3 level <17
* Received Sodium Bicarbonate 2mmol/kg over 15 minutes
'''Results:''' Sodium Bicarbonate decreased Ionized Calcium, increased Paco2 and didn't improve hemodynamics<ref>Cooper DJ, Walley KR, Wiggs BR, Russell JA. Bicarbonate does not improve hemodynamics in critically ill patients who have lactic acidosis. A prospective, controlled clinical study. Ann Intern Med. 1990 Apr 1;112(7):492-8. PubMed PMID: 2156475</ref>

===Trial 3===
Review Article included patients with PH<7
* '''Results:''' Sodium Bicarbonate didn't decrease time to improvement nor to hospital discharge<ref>Duhon B, Attridge RL, Franco-Martinez AC, Maxwell PR, Hughes DW. Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. Ann Pharmacother. 2013 Jul-Aug;47(7-8):970-5. doi: 10.1345/aph.1S014. Epub 2013 Jun 4. PubMed PMID: 23737516.</ref>

===Trial 4===
Retrospective Study of '''39 patients''' with PH<7.1
* 24 patients received sodium bicarbonate
* 15 patients control
* '''Results:''' More Hypokalemia in the experiment group, No differences in clinical or biochemical parameters <ref>Viallon A, Zeni F, Lafond P, Venet C, Tardy B, Page Y, Bertrand JC. Does bicarbonate therapy improve the management of severe diabetic ketoacidosis? Crit Care Med. 1999 Dec;27(12):2690-3. Review. PubMed PMID: 10628611.</ref>

===Trial 5===
Retrospective of '''147 pediatric''' DKA cases with PH<7.15
* 90 patients received bicarbonate
* 57 patients contol
'''Results:'''Bicarbonate didn't improve clinical outcomes, but hospitalization was prolonged with the bicarb group [http://www.ncbi.nlm.nih.gov/pubmed/?term=Ann+Emerg+Med.+1998.+Jan%3B31+(1)%3A41-8 <ref>Ann Emerg Med. 1998 Jan;31(1):41-8</ref>]

===Trial 6===
'''Systematic Review of 44 studies'''
'''Results:''' Bicarbonate use increased cerebral edema and prolonged hospitalization in pediatrics age group and increased ketosis and need for potassium supplementation[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224469/ <ref>Ann Intensive Care. 2011; 1: 23</ref>]

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-15T18:06:13Z

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2014-04-15T18:05:06Z

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EBQ:Sodium Bicarbonate use in DKA

2014-04-14T20:08:35Z

Me7sn: Me7sn moved page EBQ:Sodium Bicarbonate in Acidosis to EBQ:Sodium Bicarbonate use in DKA

==Clinical Question==
Should Sodium Bicarbonate be used to treat metabolic acidosis?

==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat Acidosis, but based on what ? Is there any evidence ?

==Pro Argument==

===Trial 1===

===Trial 2===

===Trial 3===

==Con Argument==
===Trial 1===
21 patients underwent RCT
* 10 patients (PH 6.9-7.14)received NaHco3
* 11 patients in the control group
Results: No differences in Glucose level, bicarb level nor PH <ref>Ann Intern Med. 1986 Dec;105(6):836-40</ref>
===Trial 2===
===Trial 3===

==Sources==
<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-14T17:17:23Z

Me7sn:

==Clinical Question==
Should we use Sodium Bicarbonate in Acidosis ?
==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat Acidosis, but based on what ? Is there any evidence ?

==Pro Argument==

===Trial 1===

===Trial 2===

===Trial 3===

==Con Argument==
===Trial 1===
21 patients underwent RCT
* 10 patients (PH 6.9-7.14)received NaHco3
* 11 patients in the control group
Results: No differences in Glucose level, bicarb level nor PH <ref>Ann Intern Med. 1986 Dec;105(6):836-40</ref>
===Trial 2===
===Trial 3===

<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-14T17:16:53Z

Me7sn:

==Clinical Question==
Should we use Sodium Bicarbonate in Acidosis ?
==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting it to water and Co2. Many Physicians use it to treat Acidosis, but based on what ? Is there any evidence ?

==Pro Argument==

===Trial 1===

===Trial 2===

===Trial 3===

==Con Argument==
===Trial 1===
21 patients underwent RCT
* 10 patients (PH 6.9-7.14)received NaHco3
* 11 patients in the control group
Results: No differences in Glucose level, bicarb level nor PH <ref>Ann Intern Med. 1986 Dec;105(6):836-40</ref>
===Trial 2===
===Trial 3===

<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-14T17:15:26Z

Me7sn:

==Clinical Question==
Should we use Sodium Bicarbonate in Acidosis ?
==Background==
Sodium bicarbonate is a solution which help alkalanizing the blood by binding the H+ and converting to water and Co2. Many Physicians use it to treat Acidosis, but based on what ? Is there any evidence ?
==Pro Argument==

===Trial 1===

===Trial 2===

===Trial 3===

==Con Argument==
===Trial 1===
21 patients underwent RCT
* 10 patients (PH 6.9-7.14)received NaHco3
* 11 patients in the control group
Results: No differences in Glucose level, bicarb level nor PH <ref>Ann Intern Med. 1986 Dec;105(6):836-40</ref>
===Trial 2===
===Trial 3===

<references/>
http://saudiemergencymedicine.com/should-you-use-sodium-bicarbonate-in-acidosis-stop-for-a-minute/
[[Category:EBQ]]

EBQ:Sodium Bicarbonate use in DKA

2014-04-14T16:38:48Z

Me7sn: Created page with "==Clinical Question== Should we use Sodium Bicarbonate in Acidosis ? ==Pro Argument== ===Trial 1=== ===Trial 2=== ===Trial 3=== ==Con Argument== ===Trial 1=== ===Trial 2=..."

==Clinical Question==
Should we use Sodium Bicarbonate in Acidosis ?
==Pro Argument==

===Trial 1===

===Trial 2===

===Trial 3===

==Con Argument==
===Trial 1===

===Trial 2===

===Trial 3===

<references/>

[[Category:EBQ]]

EBQ:Sgarbossa Criteria Study

2014-04-14T16:29:31Z

Me7sn:

{{JC info
| title= Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators
| abbreviation= Sgarbossa Criteria
| expansion= Sgarbossa Criteria for diagnosing MI in presence of a LBBB
| published= 1996
| author= Sgarbossa E. et al.
| journal= NEJM
| year= 1996
| volume= 334
| issue=8
| pages= 481-7
| pmid= 8559200
| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199602223340801
| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM199602223340801
| status=Under Review
}}
==Clinical Question==
How can we Diagnose Acute Myocardial Infarction in Left Bundle Branch Block patients ?

==Conclusion==
A Validated Clinical prediction rule has been Developed based on ECG criteria to Diagnose Acute Myocardial infarction in Left Bundle Branch Patients

==Major Points==
'''The Sgarbossa Criteria:'''
# ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
# ST-segment depression in leads V1, V2 or V3 with a score of 3
# ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2
With a score >3 90% of those with positive criteria will have STEMI ('''Good Speciﬁcity''')
But with negative criteria it doesn't help that much ('''Low sensitivity''')

==Study Design==

==Population==
===Patient Demographics===
* '''Median Age:''' 68 years
* '''Males:''' 64% in study group and 60% in experimental group
* '''Left Axis Deviation:''' 28% Vs. 48%
* '''Previous MI:''' 26% Vs. 59%

===Inclusion Criteria===
* '''Experiment''': Patients with LBBB and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref>
* '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref>

===Exclusion Criteria===
Patients without LBBB

==Interventions==

==Outcomes==

===Primary Outcome===
Acute Myocardial Infarction

===Subgroup analysis===

==Criticisms & Further Discussion==

==Funding==
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.

==Sources==
<references/>

[[Category:EBQ]]
[[Category:Cards]]

EBQ:Sgarbossa Criteria Study

2014-04-14T16:24:40Z

Me7sn:

{{JC info
| title= Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators
| abbreviation= Sgarbossa Criteria
| expansion= Sgarbossa Criteria for diagnosing MI in presence of a LBBB
| published= 1996
| author= Sgarbossa E. et al.
| journal= NEJM
| year= 1996
| volume= 334
| issue=8
| pages= 481-7
| pmid= 8559200
| fulltexturl= http://www.nejm.org/doi/full/10.1056/NEJM199602223340801
| pdfurl=http://www.nejm.org/doi/pdf/10.1056/NEJM199602223340801
| status=Under Review
}}
==Clinical Question==
How can we Diagnose Acute Myocardial Infarction in Left Bundle Branch Block patients ?

==Conclusion==
A Validated Clinical prediction rule has been Developed based on ECG criteria to Diagnose Acute Myocardial infarction in Left Bundle Branch Patients

==Major Points==
'''The Sgarbossa Criteria:'''
# ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
# ST-segment depression in leads V1, V2 or V3 with a score of 3
# ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2

==Study Design==

==Population==
===Patient Demographics===
* '''Median Age:''' 68 years
* '''Males:''' 64% in study group and 60% in experimental group
* '''Left Axis Deviation:''' 28% Vs. 48%
* '''Previous MI:''' 26% Vs. 59%

===Inclusion Criteria===
* '''Experiment''': Patients with LBBB and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref>
* '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref>

===Exclusion Criteria===
Patients without LBBB

==Interventions==

==Outcomes==

===Primary Outcome===
Acute Myocardial Infarction

===Subgroup analysis===

==Criticisms & Further Discussion==

==Funding==
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.

==Sources==
<references/>

[[Category:EBQ]]
[[Category:Cards]]

User:Me7sn

2014-04-12T20:38:36Z

Me7sn:

'''Abdalmohsen Ababtain, MBBS'''
* Senior Resident at Saudi Program for Emergency Medicine at King Abdulaziz Medical City, Riyadh
* Mohsen.ababtain@gmail.com
* Mobile +966531190090