pulmonary embolism

VA-ECMO for massive pulmonary embolism

A 60-year-old man presents to the ED after an episode of syncope. He is initially hemodynamically stable and undergoes CT demonstrating saddle pulmonary embolism. He returns from radiology with tachycardia and hypotension refractory to fluids and requiring vasopressor support. Bedside echo reveals RV dilation and severely reduced RV systolic dysfunction with septal flattening consistent with RV pressure overload. As you start systemic anticoagulation with heparin, you consider the indications for thrombolysis, surgical embolectomy and VA-ECMO.   

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Advanced Practice: sPESI vs Hestia Criteria for Discharge of Low Risk PE Patients

With the rise in popularity of the NOAC class of anticoagulants, more and more patients with a new diagnosis of pulmonary embolism are being discharged from the emergency department.  Multiple risk classifications tools have been developed to help identify patients at low risk of short term mortality. Read on to see if this new study determined which tool is the winner!

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Advanced Practice: Bedside Two Point Compression Ultrasound to Rule-In Pulmonary Embolism by Chad Simpkins MD

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.

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Trials Instead of Tragedy: Unexplained dyspnea on exertion in a healthy young physician....

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!

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