Patwari Academy videos: Demystifiying how ECGs work
As a nice segue from the Low Risk Chest Pain videos, below is a 3-part series on Demystifying the Electrocardiogram by Dr. Rahul Patwari. It takes talent to make the complex simple.
(more…)
PV card: Diagnosis of DVT (ACCP guidelines)
A patient presents with an asymmetric leg with trace pitting edema in the affected leg. What is your diagnostic approach to such a patient? What is the role of D-dimer and ultrasound (U/S)? Does this match the 2012 American College of Chest Physicians (ACCP) guidelines?
The first step is to determine your patient’s pretest probability because the recommendations vary based on risk. I can tell you that many ED patients come in with a Wells score of 1-2, which places them in the “moderate pretest probability” category. There are 2 approaches you can take based on the availability of resources at your site (high-sensitivity D-dimer or U/S) and the patient’s comorbidities. Are you referring your patient for a repeat outpatient ultrasound, if warranted?Walk through various patient scenarios to see how the D-Dimer and U/S come into play.
PV Card: Diagnosting DVT – ACCP Evidence Based Guidelines
Adapted from [1]
Go to ALiEM (PV) Cards for more resources.
Thanks to Dr. Jason West (EM resident at Jacobi/Montefiore) for this card idea and deciphering the complex recommendations from the publication.
Reference
- Bates S, Jaeschke R, Stevens S, et al. Diagnosis of DVT: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e351S-418S. [PubMed]
Patwari Academy videos: Low risk chest pain
One of the most common complaints in the Emergency Department is chest pain. Is it something serious? How do I risk-stratify patients with potential acute coronary syndrome? What should I be thinking of and not missing?
Rahul goes over the low-risk chest pain patient in 2 great, short teaching videos, based partly on the 2010 AHA/ACC Guideline for ACS risk stratification.
MIA 2012: Levy P et al. Subclinical hypertensive heart disease in black patients with elevated blood pressure in an inner-city emergency department. Ann Emerg Med. 2012 Oct;60(4):467-74.e1.
Bottom Line1
In asymptomatic black patients who presented to the ED with elevated blood pressure, subclinical hypertensive heart disease was detected in 9 of every 10 patients.
(more…)
MIA 2012: Canto JG et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012 Feb 22;307(8):813-22.
Bottom Line 1
Chest pain free MI is a very real phenomenon and it is associated with higher mortality – especially in younger women (NRMI study).
(more…)
MIA 2012: Hoffmann U et al. Coronary CT angiography versus standard evaluation in acute chest pain. N Engl J Med. 2012 Jul 26;367(4):299-308.
Bottom Line 1
ROMICAT-II study: Coronary CT angiography (CCTA) is a safe and faster diagnostic strategy than the standard evaluation of low-to-intermediate risk chest pain patients. CCTA, however, results in higher radiation exposure and more downstream testing.