PV Card: Focused Abdominal Aorta Ultrasound

UltrasoundIn this next ultrasound installment in the PV Card series, Drs. Victoria Koskenoja, Heidi Kimberly, and Mike Stone succinctly summarize the focused abdominal aorta ultrasound to assess for an abdominal aortic aneurysm (AAA). These can serve as key reference cards when you do your next AAA scan. Don’t miss the last card with tips on optimizing the view and common pitfalls.

(more…)

2017-08-03T00:21:42-07:00

Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED

AFibIntravenous beta blockers and non-dihydropyridine calcium channel blockers are recommended first-line for atrial fibrillation (AF) with rapid ventricular rate (RVR) [1]. In a previous post, Bryan Hayes (@PharmERToxGuy) provided an overview of the data comparing beta blockers to calcium channel blockers for atrial fibrillation rate control in the ED. Here is part 2 of our two-part AF series.   (more…)

2016-11-16T09:41:30-07:00

Diagnose on Sight: Swollen Upper Extremity in a Patient with End Stage Renal Disease

AV fistula pseudoaneurysmCase: A 45 year old female with end-stage renal disease presents with 2 days of worsening pain, swelling, and color change of her left upper extremity.  The symptoms began after her left arm arteriovenous (AV) fistula was accessed for hemodialysis. The skin is tense and a bruit is present. What is your diagnosis for this swollen upper extremity? Click on the image for a larger view.

(more…)

2016-12-22T20:07:29-07:00

ADJUST-PE Study: ALiEM-Annals of EM Journal Club

ALiEM-AnnalsEM-SquareWe are very excited this month to bring you our fourth ALiEM-Annals of EM Global Journal Club on the use of age-adjusted D-dimer levels to help exclude the diagnosis of pulmonary embolism (PE). We hope you will participate in an online discussion of the four posted questions below from now until August 29th. Respond by commenting below or tweeting (#ALiEMJC). Mark your calendars: On Thursday, August 28th at 16:30 CST (17:30 EST), we will be hosting a 30-minute live Google Hangout with Drs. Jeff Kline and Jonathan Kirschner, the authors of the Annals of Emergency Medicine Journal Club for the ADJUST-PE Trial, that is informed by the discussion. Later this year, a summary of this journal club will hopefully be published in Annals of EM.

(more…)

2017-03-05T14:18:40-07:00

Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers?

Screen Shot 2014-05-27 at 2.26.48 AMRate control with IV medications is recommended for atrial fibrillation in the acute setting in patients without preexcitation. This was a Class 1 recommendation (Level of Evidence B) per the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation [1]. What does the evidence say? Are calcium channel blockers or beta blockers better?

(more…)

Deep Vein Thrombosis (DVT): Wells criteria and D-dimers happy together

DVTYou are evaluating a 45-year-old male who is complaining of calf pain. He has a history of cancer however he has never had a clot in the past.   The leg is neither swollen nor warm but he notes a cramping sensation in the posterior portion of his calf.  You are concerned for a deep vein thrombosis (DVT) and consider the multiple means to reliable exclude the diagnosis: Wells score, D-dimers, ultrasound? What works?

(more…)

2016-11-11T19:46:08-07:00

PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism

Pulmonary embolism
ExpertPeerReviewStamp2x200
Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE.

(more…)