When the PERC Rule Fails

PEKline et al developed a clinical decision tool based on parameters that could be obtained from a brief initial assessment to reasonably exclude the diagnosis of pulmonary embolism (PE) without the use of D-dimer in order to prevent unnecessary cost and the use of medical resources. 1 Many of us have used the Pulmonary Embolism Rule-out Criteria (PERC) rule by now, but we should be clear on what it includes. Are we using it appropriately?

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Lactic Acidosis and Beta Agonist Therapy in Asthma

NebulizersmA 45 y/o male with moderate persistent asthma presents with wheezing and cough following a viral URI. He is tachypneic and has diffuse wheezing. PEFR is 250 (>50% below his normal). Initial ABG is 7.46/33/70 on room air with a lactate of 2.0 mmol/L. He receives IV steroids and 4 rounds of albuterol nebulizers.  On repeat evaluation, his work of breathing and wheezing have improved and his PEFR is now >300. He is completed alert and oriented with a BP of 118/70 and a HR of 110. Repeat ABG shows 7.35/35/100 on room air; however, his lactate is now 7 mmol/L.

Clinical Question

Is the rise in his lactate expected following beta-agonist therapy?
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2018-05-31T06:31:12-07:00

Subsegmental Pulmonary Embolisms (SSPE) are Important

0125Multi-detector computed tomographic pulmonary angiography (CTPA) allows for better visualization of peripheral pulmonary arteries allowing for diagnosis of small peripheral emboli limited to the subsegmental pulmonary arteries. Interestingly as these SSPE’s get diagnosed more and more, two questions come to mind:

  1. What is the prognostic utility of diagnosing SSPEs?
  2. What is the morbidity and mortality of SSPEs compared to more proximal PEs?

A recent study in 2013 Blood looked at these questions. 1

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2019-09-10T13:35:08-07:00

The Not-So-Sick Health-Care Associated Pneumonia Patient: New Treatment Strategy

Case 1 RUL Apical Segment PA

Health-care associated pneumonia (HCAP) is the term used to describe patients presenting with pneumonia who may be at higher risk of multi-drug resistant (MDR) pathogens than other patients presenting from the community due to recent contact with the health care system. What are the criteria for HCAP?

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2016-11-11T19:17:36-08:00

52 Articles in 52 Weeks: Landmark EM Articles 2013

52To provide a resource for evidence-based Emergency Medical education, this list of must-read landmark articles was created to supplement the Emergency Medicine (EM) internship year of training. There are 52 articles so that one article can be read at leisure each week of the year. I searched national databases and polled faculty at the University of Washington to identify articles that faculty would expect any EM resident to be familiar with or that they felt were practice-changing in EM. Articles were selected for the final list based on the quality of study design, sample size, and relevance for EM residents.

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