A deep dive analysis of current topics in Emergency Medicine
Note: The cases discussed in this post happened before COVID-19. Given that D-Dimer may be elevated in patients with COVID-19, the pretest probability of PE in your patient population may be elevated at this time. Thus, the assumptions derived from Kohn et al’s paper highlighted in this post may not Read more…
Introduction As far as dangerous causes of chest pain go, acute aortic syndromes (aortic dissection, intramural thrombus, and penetrating aortic ulcer) can present a real diagnostic dilemma. They’re rare (with a prevalence of around 2-4 per 100,000 individuals), seem to present in a myriad of ways, and are invariably life-threatening. Read more…
As some of you may have heard, COVID-19 is a thing. We’ve covered it in-depth, here. Fortunately, there’s a cure. President Trump touted it himself and therefore it must be true. So good – so, so good that this will all be over by Easter. Could this be true? Let’s Read more…
In our last two pieces on pulmonary embolism (PE), 1 and 2, we discussed five studies that attempted to describe the prevalence of pulmonary embolism in patients presenting to the ED with syncope. In this post, we will review some common methodologies for working up PE in the ED. PE Read more…
What is the prevalence of PE in patients who present to the ED with syncope? (This is part 2 of a two-part series.) In our last post, we discussed four studies that attempted to describe the prevalence of pulmonary embolism in ED patients who have experienced syncope. In this post, Read more…
What is the prevalence of PE in patients who present to the ED with syncope? References 1. Prandoni P, Lensing AWA, Prins MH, et al. Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope. N Engl J Med [Internet]2016;375(16):1524–31. Available from: https://doi.org/10.1056/NEJMoa1602172 2. Oqab Z, Ganshorn H, Sheldon R. Prevalence Read more…
Last month Academic Emergency Medicine published the article “Can emergency physician gestalt ‘rule in’ or ‘rule out’ acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study”. The following is a critique by Dr. deSouza and Dr. Sinert: In this large multi-center, prospective diagnostic accuracy study, the investigators conclude Read more…
In last week’s post, we reviewed Pluymaekers et al (1), a randomized control trial from the Netherlands on early or delayed cardioversion for recent-onset atrial fibrillation (AF). In this post, we will analyze our practice in the U.S. and discuss some of the arguments for and against cardioversion in the Read more…
A recent NEJM article, “Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation” by Pluymaekers et al has reinvigorated debate in the blogosphere, academia conference halls, and podcast-dom over management of recent-onset atrial fibrillation (AF) (1,2,3). Prior studies have demonstrated that cardioversion for recent-onset atrial fibrillation (typically defined by a duration Read more…
From the last two posts (Part 1 and Part 2) we know that observing patients for chest pain to “rule out ACS” may no longer be relevant now that we have new diagnostic modalities and updated evidence. The tests we do in the observation unit are unlikely to help us Read more…