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ECG Cases 26: Pulmonary Embolism and Acute RV Strain

In this month's ECG Cases Dr. Jesse McLaren runs through 10 cases and explains how the ECG can be integral in the diagnosis and management of pulmonary embolism, even though it is not incorporated into any of the commonly used decision tools for diagnosis of pulmonary embolism...

EMU 365 Thrombolysis in Pulmonary Embolism with Amit Shah

The final EMU365 video from EMU2018 features Dr. Amit Shah who discusses decision making and dosing around the use of thrombolytics in PE in the context of cardiac arrest, massive PE and submassive PE; the controversy around using half dose alteplase, and nuanced decision making around which patients with submassive PEs should have thrombolysis...

BCE 77 Pulmonary Embolism Workup in Pregnancy

This Best Case Ever elucidates the practical challenges of working up pregnant patients in the ED with a suspicion of pulmonary embolism. Since this recording, the first ever multi-center prospective outcome study looking at the pulmonary embolism workup in pregnancy was published in the Annals of Internal Medicine. A suggested algorithm and analysis of the study by Lauren Westafer are provided in these show notes....

Ep 114 Pulmonary Embolism Challenges in Diagnosis 2 – Imaging, Pregnancy, Subsegmental PE

In Part 1 of Pulmonary Embolism Challenges in Diagnosis Drs. Helman, Lang and DeWit discussed a workup algorithm using PERC and Wells score, the bleeding risk of treated pulmonary embolism, pearls in decision making on whether or not to work up a patient for pulmonary embolism, how risk factors contribute to pretest probability, the YEARS criteria and age-adjusted D-dimer. In this Part 2 we answer questions such as: what are the important test characteristics of CTPA we need to understand? Which patients with subsegmental pulmonary embolism should we treat? When should we consider VQ SPECT? What is the best algorithm for the work up of pulmonary embolism in pregnant patients? How best should we implement pulmonary embolism diagnostic decision tools in your ED? and many more…

Ep 113 Pulmonary Embolism Challenges in Diagnosis Part 1

Dr. Kerstin DeWit and Dr. Eddy Lang answer the questions that plague us on almost every shift: Which patients require any work-up at all for PE? What’s the utility of PERC and Well’s scores? Should the newer YEARS decision tool supplant Well’s? When should we order a D-dimer? What’s the diagnostic role of CXR, ECG, POCUS, CTA and VQ? How should we work up pregnant patients for PE? How can we use shared decision making strategies for PE to help us do what’s best for our patients, and many more...

Best Case Ever 44 Low Risk Pulmonary Embolism

Dr. Salim Rezaie of R.E.B.E.L. EM tells his Best Case Ever of a Low Risk Pulmonary Embolism that begs us to consider a work-up and management plan that we might not otherwise consider. With new guidelines suggesting that subsegmental pulmonary embolism need not be treated with anticoagulants, exceptions to Well's Score and PERC rule to help guide work-ups, the adaptation of outpatient management of pulmonary embolism, and the option of NOACs for treatment, the management of pulmonary embolism in 2016 has evolved considerably. In which situations would you treat subsegmental pulmonary embolism? How comfortable are you sending patients home with pulmonary embolism? How does the patient's values play into these decisions? Listen to Dr. Rezaie provide an insightlful perspective on these important issues and much more...

Episode 21: Pulmonary Embolism

In this episode on Pulmonary Embolsim we have the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto, and Dr. John Foote the CCFP(EM) residency program director at the University of Toronto. We kick it off with Dr. Foote's approach to undifferentiated dyspnea and explanation of Medically Unexplained Dyspea ('MUD') and go on to discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well's criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE are reviewed.

EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine

In this month's EM Quick Hits podcast, Anand Swaminathan on tips and tricks in polytrauma, Rohit Mohindra on diagnosis and management of toxic megacolon, Jesse McLaren on ECG in pulmonary embolism, Victoria Myers on approach to the patch call for cardiac arrest, Brit Long on when to do a CT head before LP, Salim Rezaie on nebulized ketamine - the ketaBAN study...

EM Quick Hits 23 – Clinical Probability Adjusted D-dimer, ARDS Part 2, Pharyngitis Mimics, Barotrauma, Vertigo, CPR Gender-Based Differences

In this month's EM Quick Hits podcast we have Salim Rezaie on clinical probability adjusted D-dimer for pulmonary embolism, Bourke Tillmann on ARDS for the ED Part 2, Brit Long & Michael Gottlieb on pharyngitis mimics, Justin Hensley on the many faces of barotrauma, Hans Rosenberg & Peter Johns on assessment of continuous vertigo and Justin Morgenstern & Jeannette Wolfe on gender-based differences in CPR...

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