JournalFeed Weekly Wrap-Up
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pe
Ultrasound G.E.L. – Multiorgan Ultrasound for Pulmonary Embolism
The emDOCs team is happy to be reposting Ultrasound G.E.L. content in their never ending coverage of evidence based ultrasonography (EBU). In this post, does combining multiple POCUS for PE make for a more accurate exam?
Ultrasound G.E.L. – Multiorgan Ultrasound for Pulmonary Embolism Read More »
ACS Mimics: ED Differential Diagnosis and Approach to Management
ACS may present in various fashions, and many other deadly conditions can mimic ACS. How can you differentiate these conditions? This post evaluates several diseases that appear similar to ACS.
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When is Capnography Useful in the ED? Part II
Welcome to Part II of capnography uses in the ED. Capnography is increasingly being utilized in the ED, primarily for endotracheal intubation, cardiac arrest, and procedural sedation. This post will introduce you to several other uses for capnography.
When is Capnography Useful in the ED? Part II Read More »
Controversies in Pulmonary Embolism Imaging and Treatment of Subsegmental Thromboembolic Disease
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.
ACCP Guidelines Update for Thromboembolic Disease
What are the new updates for DVT and PE from the American College of Chest Physicians? This post provides a summary of the key recommendations for EM providers.
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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? […]
Outpatient PE treatment Read More »
PERC Rule: Application and Limitations
“Pleuritic chest pain […] is not in a validated clinical decision rule despite having a higher OR for PE than hemoptysis and recent immobilization”
The PERC rule can be a wonderful thing, but requires judicious use. Jason West, MD reviews the literature, discussing applicability and limitations of the PERC rule, so you’ll know when to feel confident foregoing the D-dimer and when to be more cautious.
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