You evaluate a patient complaining of acute onset of dyspnea with hypotension and hypoxia. You immediately consider the diagnosis of acute massive pulmonary embolism, but despite your best efforts can't get good cardiac windows on bedside ultrasound. Should you administer thrombolytics? Heparin? Send the shocky patient for a CT? Today Dr. Simpkins goes through the steps to perform 2-point compression ultrasound of the lower extremity to evaluate for DVT, an easy and rapid bedside test that may allow for indrect but more rapid diagnosis of acute, massive pulmonary embolism.
Debating about discharging a patient from the ED with newly diagnosed PE? For her critically appraised topic, Dr. Sumaya Mekkaoui reviewed some literature on the safety of early outpatient treatment for patients with a low-risk pulomary emobolism.
Think just because you are a young, healthy physician that you are invinceable? Read this post and remember that we are vulnerable too...even more so because we often refuse to acknowledge when we are sick. This week's Advanced Practice topic comes to us courtesy of a Cooper EM alum. The story is told with full permission from the patient, his wife, though names are omitted to prevent any possible HIPPA entanglements!
As the treatment of malignancy evolves, the number patients who are receiving active chemotherapy presenting to the Emergency Department is increasing. Many of these patients present with respiratory chief complaints ranging from mild dyspnea to acute respiratory distress. This post aims to introduce chemotherapy-induced pulmonary toxicity and review those chemotherapuetic agents that commonly affect the lungs.
Dynamic hyperinflation (autoPEEP, air trapping, etc.) is a process leading to an increase in end-expiratory lung volumes and increased airway pressures. This process may occur secondary to obstructive lung pathology and/or an increase in minute-ventilation without sufficient time for expiration. The pathologic effects of dynamic hyperinflation include an increased work-of-breathing, barotrauma, pneumothorax, and an increase in intrathoracic pressure leading to a decrease in cardiac output and possible hemodynamic collapse. Rapid identification of this process is crucial for reversing it.
In the setting of a severe asthma exacerbation that is refractory to medical mangagment and noninvasive ventilation, mechanical ventilation can be life-saving. However, the ventilator can quickly kill your patient if careful thought is not taken to address the unique respiratory needs and pulmonary physiology inherent to severe asthma.
The mild, moderate, or severe asthma exacerbation is cemented in the practice of Emergency Medicine. As a provider of this great speciality, one should be intimately familiar with the range of therapies employed. The goal of this post is to provide a high-yield review of the therapies we use (or sometimes use) while treating these patients.