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Stress testing: a beginner’s guide

Stress testing: a beginner’s guide Author: Jason Brown, Capt, USAF, MD (EM Resident Physician, University of Maryland) // Editor: Alex Koyfman, MD Stress tests are aptly named in that the goal is to cause a physiologic stress and to, through a variety of modalities, detect that stress’ impact on the myocardium. There are three major […]

practice updates

Posterior Stroke, HiNTS exam

Author: Jason Brown, MD (EM Resident Physician, University of Maryland) // Editor: Alex Koyfman, MD Background Posterior strokes make up 1 in every 5 ischemic strokes in the US.  That equates to about 150,000 strokes per year involving the posterior circulation with an incidence of 18/100,000.  Bottom line: This is a common, emergent diagnosis that […]

practice updates

The Wheeze That Wasn't – An Observation on Enterovirus D-68

These children are often a mixed picture of viral bronchitis/bronchiolitis PLUS an asthma exacerbation. Treatment with albuterol, ipratropium, magnesium sulfate, steroids, fluids, etc are all reasonable and prudent in this population. If they begin to clinically improve within 30 minutes then you can feel good about soothing their reactive airways. However, they still have underlying viral issues which may require non-invasive positive pressure ventilation (either high-flow nasal cannula or BIPAP). If they do not improve within 30 minutes then you should begin to plan for IMC/ICU admission as these patients will require significant monitoring and respiratory support.

practice updates

Outpatient PE treatment

Editor's note: This post was listed in the LITFL Review 153's "Best of #FOAMed" category. Venous thromboembolism (VTE) (deep vein thrombosis or pulmonary embolism) has an incidence of roughly 1 in 1,000 with an incidence of PE with or without DVT of 2.3 per 10,000. One major factor to consider is that VTE is much more common in the elderly and has a mortality highly associated with co-morbidities such as cancer and underlying cardiovascular disease. In the distant past any diagnosis of DVT and/or PE would result in admission for heparin bridging to oral anticoagulation therapy. This was largely due to a fear that outpatient management would lead to an increase in fatal embolic or major bleeding events. However, there is a great amount of literature that has established the safety of outpatient management of “low-risk” DVT; outpatient treatment has become standard of care for these patients. “Low-risk” patients were those with no prior VTE, no PE, no prior heparin use, and no confounding co-morbidities (cancer, infection, stroke, etc). So what about PE? If outpatient management is standard of care for a select group of DVT patients, then can we treat PE as an outpatient? [...]