Pulmonary embolism (PE) is one of the big “can’t miss” diagnoses in the emergency department. Unfortunately, presenting symptoms are often vague, and definitive diagnostic testing is expensive and comes with risks of radiation and contrast to the patient. In order to avoid missing a PE while mitigating the risks associated with overtesting, some clinical decision tools have been created to aid in the diagnostic process. We will focus on two of these commonly used decision tools: the PERC rule and the WELLS score for PE.Read More
This weeks grand rounds started off with our Morbidity and Mortality conference led by Dr. Shaw who led us on an education expedition covering the use of REBOA, surgical vs. medical management in spontaneous miscarriage, ways we can improve our use of the electronic medical record, management of a persistent air leak in a patient with a chest tube, and the role of CT in CAP. Dr. Alwan then provided us an in-depth look at the often untold challenges of life as a refugee as well as the challenges we face in providing care for these patients. This was followed by Dr. Randolph who presented a case of an incredibly complicated patient with a pulmonary embolism to highlight the steps in management of a decompensating patient with a pulmonary embolism before you initiate thrombolysis. Next up was Dr. Gottula and Dr. Hinckley who went head to head with a challenging presentation of acute aortic dissection as part of our CPC lecture series. Dr. Leech then finished up the day with a case based discussion on the utility of the Kocher Criteria in the evaluation of child with an acutely painful hip.Read More
Last week our Journal Club focused on the treatment of hemodynamically significant pulmonary emboli. These are pulmonary emboli causing either frank hypotension (sometimes called massive or high risk PEs) or causing significant right heart strain as evidenced by CT findings, cardiac biomarker elevation, or bedside Echo findings. Drs. Grace Lagasse, Kari Gorder, and Claire O'Brien led us in a discussion of the 3 papers linked in the article. Read the papers yourself, listen to the podcast, read the summaries and get caught up on all things PE.Read More
A 45 yo Female presents to the ED with sudden onset of chest pain, described as worse when taking a deep breath. She is significantly short of breath and appears distressed. She recently underwent a total right knee arthroplasty and reports having been bedridden secondary to pain. Physical exam is remarkable for a right lower extremity with surgical incisions that clean, dry, intact; however, her left lower extremity is swollen with significant tenderness along the popliteal fossa and calf.
Vitals: Temp 99.2HR 120RR: 28 BP: 130/80 SpO2 90% on RA.
A CTPA is ordered...Read More
Evidence-Based Medicine: Meningitis with Drs. O'Brien and Teuber
- In one study, 95% of people with meningitis had 2 of fever, headache, meningismus but only 44% had all 3
- CT prior to LP? The American College of Radiology says do it for papilledema, altered mental status, focal neuro deficit, immunocompromised stated, history of CNS disease.