PV card: PE Severity Index (PESI) score

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).

(more…)

2017-08-03T00:39:08-07:00

Nov 17, 2012 | ALiEM Cards, Cardiovascular, Pulmonary

By: Michelle Lin, MD

D-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.

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

2019-01-28T22:17:31-08:00

Jul 27, 2012 | ALiEM Cards, Cardiovascular, Pulmonary

By: Michelle Lin, MD

Paucis Verbis: Ventilator settings for obstructive lung disease

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.

2017-08-03T00:15:44-07:00

Oct 21, 2011 | ALiEM Cards, Pulmonary

By: Michelle Lin, MD

Paucis Verbis: Ventilator settings for acute lung injury and ARDS

A patient presents with severe multilobar pneumonia and refractory hypoxia requiring endotracheal intubation. The respiratory therapist connects your patient to the ventilator.

“What settings would you like your patient on?”

(more…)

2017-08-03T00:16:34-07:00

Oct 14, 2011 | ALiEM Cards, Pulmonary

By: Michelle Lin, MD

Paucis Verbis: Legionella pneumonia

Did you know that there was an unexplained spike in Legionnaire’s disease (pneumonia caused by Legionella pneumophila) during the 2009 H1N1 flu pandemic?

Since the flu season is rapidly approaching, I thought I would review what Legionnaire’s disease looks like. Yes, they will have a fever, cough, and pneumonia on CXR. These patients are generally pretty sick and almost always need hospitalization. What makes it unique? The trick is to look for extrapulmonary findings, which help to distinguish it from other atypical pneumonias. Relative bradycardia is a sure tip.

(more…)

2017-08-01T23:52:53-07:00

Sep 16, 2011 | ALiEM Cards, Pulmonary

By: Michelle Lin, MD

When would you give fibrinolytics for a Pulmonary Embolism?

This Paucis Verbis card summarizes recommendations found in Circulation’s recently published Scientific Statement from the American Heart Association. Although it is rare to give fibrinolytics for a pulmonary embolism (PE) in the Emergency Department, it is important to remember when lytics are indicated.

(more…)

2017-08-03T00:46:18-07:00

Jul 29, 2011 | ALiEM Cards, Cardiovascular, Pulmonary

By: Hans Rosenberg, MD

Paucis Verbis: Pulmonary Embolism Clinical Prediction Rules

“Should I get a D-Dimer test or CT chest angiogram on my patient with atypical chest pain to rule-out a pulmonary embolism?” This is a common question asked by emergency physicians on a routine basis.

Here are 3 clinical prediction rules: PERC, Wells, and Simplified Geneva Score. Personally, I’ve never used the Geneva Score, but it’s worth looking at.

(more…)

2019-01-28T22:48:10-08:00

Jun 3, 2011 | ALiEM Cards, Pulmonary

By: Michelle Lin, MD

Previous 1···567 Next