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13 03, 2013

Lytics for sub-massive PE: Ready for primetime?

2016-11-11T18:39:33+00:00

PulmonaryembolismThere was recently a great study published in the American Journal of Cardiology (2012) by Sharifi et al1, questioning whether we should be considering tPA in patients other than those patients with massive pulmonary embolism (PE)? You know the big “Saddle Embolus” we all fear? Well it turns out this is only about 5% of all PEs.

Should we be considering tPA in patients with sub-massive PEs?

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6 03, 2013

PE in pregnancy: which diagnostic tests do you use?

2017-03-05T14:18:48+00:00

Pulmonary embolism (PE) can be a deadly disease and one of the most challenging diagnosis to make in a pregnant patient. Patients may present with signs and symptoms that might also be present in a normal uncomplicated pregnancy. Even in nonpregnant patients, the diagnosis of venous thromboembolism (VTE) such as PE can be quite challenging.

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31 01, 2013

PV card: VBG versus ABG

2017-08-03T00:16:50+00:00

You obtain a venous blood gas (VBG) on a patient with a COPD exacerbation because you are concerned about hypercarbia. You get a value of 55 mmHg. How correlative is that compared to an arterial blood gas (ABG).

There has been a lot of literature on how well the pH correlates between the ABG and VBG but what about pCO2?

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17 11, 2012

PV card: PE Severity Index (PESI) score

2017-08-03T00:39:08+00:00

Do you send some of your low-risk patients with pulmonary embolism home?

This is a controversial issue which warrants a look at risk stratification tools. The primary one used is the validated Pulmonary Embolism Severity Index (PESI) score. In Lancet 2011, the authors looked at whether PESI class I and II (low risk) patients could be managed safely as outpatients. It turns out in their study, regardless of whether their PESI class I and II patients were treated as outpatients and inpatients, all fared equally well from a complications standpoint (recurrent clot, bleeding from anticoagulation).

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27 07, 2012

Paucis Verbis: D-Dimer test

2019-01-28T22:17:31+00:00

LabD-Dimer: To order or not to order?

That’s the question when it comes to risk stratifying a patient for a pulmonary embolism with a low pretest probability. One should consider confounding conditions which may cause an elevated D-Dimer level. There’s always confusion about what may cause an elevated D-Dimer besides venous thromboemboli. So I thought I would make a pocket card as a reminder.

PV Card: D-Dimer Test


Adapted from 1
Go to the ALiEM Cards site for more resources.

1.
Wakai A, Gleeson A, Winter D. Role of fibrin D-dimer testing in emergency medicine. Emerg Med J. 2003;20(4):319-325. [PubMed]
21 10, 2011

Paucis Verbis: Ventilator settings for obstructive lung disease

2017-08-03T00:15:44+00:00

Ventilator

Following up with last week’s Paucis Verbis card on Ventilator Settings for Acute Lung Injury and ARDS, here is the card on Ventilator Settings for Obstructive Lung Disease. This is for patients who present with acute asthma or COPD exacerbation who require endotracheal intubation.

What initial ventilator settings should you set for these patients?

 


Go to the ALiEM Cards site for more resources.

Thanks to Dr. Jenny Wilson for the card and Dr. Scott Weingart for the original stellar podcast from which this card was derived.