Suppose you have a patient in whom you highly suspect a pulmonary embolism (PE) that devolves into PEA arrest while awaiting a CT angiogram. Or, what about a patient with an ECG showing clear STEMI that loses pulses?
There 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?
In the third and fourth video in the Trauma series (first two videos = primary and secondary survey), Dr. Rahul Patwari discusses about chest trauma, divided into blunt and penetrating mechanisms. What is “the box” that everyone keeps referring to?
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.
What’s the primary and secondary survey in the assessment of the trauma patient? This is a great review of the methodical approach and insight in the thought processes by Dr. Rahul Patwari.
Bell’s Palsy is an idiopathic unilateral facial nerve paralysis.
Since the 2009 Cochrane review1 showing that antivirals added no benefit to corticosteroids in Bell’s Palsy, I stopped prescribing them. The NNT.com site has concluded the same. Looking at the literature a little more, the recommendations are a little murkier. Some groups are still advocating for antivirals for severe cases, because there may be a very small but questionably positive benefit.
Adapted from [1, 2, 4]
Go to ALiEM (PV) Cards for more resources.
Thanks to Dr. Kristin Berona (UCSF-SFGH EM resident) for the idea and notes!
Have you ever wondered why prescription eyedrops have different color bottle caps? Did you know that the American Academy of Ophthalmology (AAO) has a policy to color-code topical ocular medication bottles caps?
“The Academy’s policy on color coding of eyedrop drug caps was prompted by reports to the Academy and the National Registry of Drug-Induced Ocular Side Effects of serious adverse events resulting from patient difficulty in distinguishing between various ocular medications. With input from the pharmaceutical industry and the Food and Drug Administration (FDA), the Academy’s Committee on Drugs developed a uniform color-coding system.” — AAO policy statement
This totally makes sense. I would think the highest-risk population to mix up medications are those with vision problems. The colors help serve as an safeguard against error.