PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism

Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE.

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By Salim Rezaie, MD|2019-09-10T13:34:00-07:00Apr 11, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary|

Blood Cultures in Pneumonia

A 75 year old woman is found to have pneumonia. With a CURB-65 of 3 and a PORT score of 95, she is correctly treated her for community acquired pneumonia with Ceftriaxone and Azithromycin, and admitted. Unfortunately, the admitting service points out that no blood cultures were drawn! What is the evidence for this?

Originally from Clinical Monster blog

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By Andrew Grock, MD|2026-06-16T16:04:59-07:00Feb 17, 2014|Infectious Disease, Pulmonary|

When the PERC Rule Fails

Kline 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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By Jason West, MD|2016-11-11T19:19:14-08:00Feb 11, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary|

Lactic Acidosis and Beta Agonist Therapy in Asthma

A 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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By Mac Walter, MD|2018-05-31T06:31:12-07:00Dec 18, 2013|Pulmonary, Tox & Medications|

Bicarbonate: Completely Useless?

Intravenous sodium bicarbonate seems like a wonderful drug. It fixes acidosis, pushes potassium into cells, alkalinizes urine, and even helps with smelly feet. However, this literature review of four conditions casts some doubt into the seemingly cure-all that is bicarbonate.

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By Andrew Grock, MD|2016-11-11T19:17:46-08:00Dec 4, 2013|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pulmonary, Renal|

Subsegmental Pulmonary Embolisms (SSPE) are Important

Multi-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:

What is the prognostic utility of diagnosing SSPEs?
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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By Salim Rezaie, MD|2019-09-10T13:35:08-07:00Nov 27, 2013|Cardiovascular, Critical Care/ Resus, Pulmonary|

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

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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By Emily Heil, PharmD, BCPS, AAHIVP|2016-11-11T19:17:36-08:00Nov 26, 2013|Infectious Disease, Pulmonary|