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Brit Long

Controversies in Pulmonary Embolism Imaging and Treatment of Subsegmental Thromboembolic Disease

5 Comments / FOAMED, In the Literature, practice updates /

Pulmonary embolism (PE) is classically a life-threatening diagnosis, often considered in the work-up of patients with chest pain or dyspnea. Initial mortality rates of missed, untreated PE has been quoted as high as 26%, based on a 1960 study. This disease is common, with 400,000 patients affected with nonfatal PE and another 200,000 patients in the U.S. dying each year from this disease. PE is the third most common cause of death in cardiovascular disease after myocardial infarction and stroke.

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Occult Sepsis in Traumatic Injuries

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Trauma patients require systematic resuscitation and definitive treatment. However, there are sometimes underlying reasons for the injury, such as syncope prior to the injury or even an underlying infection that made him or her prone to injury. Not all trauma patients will be unstable from their injury and they may have underlying comorbidities that need to be uncovered and treated. This article reviews some basic steps that can be taken to evaluate for underlying infection in trauma patients.

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Clinical Decision Rules Series Part 2: CDR Implementation

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There are often multiple roadblocks to incorporating a CDR into clinical practice. These can be broken into the 1) individual provider and 2) the institution.

1. Emergency physicians are a rare breed, and many of us do not appreciate suggestions on how to practice. Individual providers vary in many regards: training, knowledge, experience, and gestalt. Workups and treatments can significantly differ among providers. With CDRs, physicians may be hesitant to apply these rules to their own practice. They may feel the rules are too complex, too difficult to remember, or detract valuable time from patient care. Providers often feel that gestalt or experience is better than rules.

2. Institutions may have habits or a culture for particular conditions that may make it difficult to apply a rule. Tradition or consultant availability may color the use of CDRs. Unfortunately, the medico-legal environment or funding can also play a large role in the use, or lack thereof, for CDRs.

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The Clinical Decision Rules Series (Part 1)

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Clinical decision rules (CDRs) are everywhere in medicine today. They were developed to improve our decision-making capability. We are constantly under stress to improve throughput and diagnostic capabilities. CDRs are appealing in that they strive to take murky, unclear variables and change them into a structured tool or assessment. They can potentially take more factors into account than the typical physician at the bedside and give consistent results if applied appropriately.

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Controversies of Thrombolytics for Pulmonary Embolism

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Pulmonary embolism (PE) is a disease process associated with significant morbidity and mortality. The benefits of thrombolytics for massive PE has been established in the literature. But what does the evidence say about the use of thrombolytics for submassive PE? What are the current guidelines and recommendations? As emergency physicians how should we apply the current evidence for the use of thrombolytics in submassive PE?

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