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? [...]

Diagnose important traumatic injuries quickly, avoid unnecessary ionizing radiation in kids, and do so with an extremely easy ultrasound application to learn. Moreover, skull fracture found to be more predictive than scalp swelling or vomiting for traumatic brain injury, increasing likelihood by 4-fold to 20-fold.

Our ongoing intern report series is the product of first-year EM residents at UT Southwestern exploring clinical questions they have found to be particularly intriguing. For med students & junior residents - if you haven't encountered these issues yet, you will!

• A Case of Elevated BP by Benjamin Trevias, MD
• Elevated B-hCG Outside of Pregnancy by Gray Millsap, MD
• Blood Pressure Management in the Emergency Care Setting by John R. Corker, MD
• Bronchiolitis by Stace Breland, DO
• Calcium Channel Blocker in Subarachnoid Hemorrhage by Emberlynn Liu, MD
• An Unusual Case of Tachycardia by Ashley Phipps, MD
• What's the Deal with Flumazenil? by Ian Bodford, MD
• A Review of Induction Agents Used in Rapid Sequence Intubation by Brandon Morshedi, MD
• Debunking a Myth: The Use of Lidocaine with Epinephrine for Digital Anesthesia by Richard B. Moleno DO, MS
• Presentation, Diagnosis, and Treatment of Lyme Disease by Meaghan Dehning, MD
• NEXUS vs Canadian C-Spine Rules by Justin Yuan, MD
• Preoxygenating the Difficult to Oxygenate Patient by Alex Cohen, MD
• P Wave Dispersion and Pediatric Syncope by Nnenna Ejesieme, DO
• QT Prolongation by Lindsay Schroeder, MD
• Recognizing Rhabdomyolysis in the ED by Chris Chase, MD
• Scaphoid Fractures by Christina Smith, MD

Etiologies, Clinical Course, Diagnosis, Management...and ED PEARLS

Influenza is spread primarily through large respiratory droplets or contamination of surfaces. About 4 days after exposure patients will typically start to develop an abrupt onset of fever, headache, myalgias or dry cough—generally this presentation will be considered an uncomplicated influenza illness. Symptoms usually resolve after 3-7 days from onset. Patients can have a more complicated course if they have primary influenza pneumonia, exacerbation of underlying medical conditions like COPD, or secondary bacterial pneumonia (Strep pneumoniae, Staph aureus, community-acquired MRSA, Haemophilus influenza are the more common pathogens). There is not a validated and widely used decision rule to help distinguish influenza from other viral pathogens based on signs and symptoms. We do know that there is some seasonal variance with influenza being more common in winter months. We also have laboratory tests like respiratory panels to screen for influenza. However, the poor sensitivity and uncertain utility of these tests makes their value in the typical uncomplicated influenza presentation questionable. Treatment recommendations, supported by the CDC, IDSA, and WHO have come under recent scrutiny—we should ALL be familiar with the recent data on influenza treatment. [...]

Diagnose your patients faster, improve ED flow, and avoid unnecessary ionizing radiation,