This week we’ll be taking a look at PE.
Heres some thoughts to keep you up at night and think twice about whos that knocking on your door.
- Whats the big deal with PE?
- Do you PERC WELL? Or should you be more PESI-mistic?
- Who to work up and how?
- Role of Age adjusted D-Dimer? What about pregnancy adjusted d-dimer?
- See PE in the ECG............Wheeeee!
- Role of Troponin, BNP, ECG and USS in prognosticating and deciding on management.
- Managing the sub-massive PE.
- Managing the Massive PE.
- Thrombolysis vs Embolectomy
- Thrombolysis – is it only for the Massive PE?
- What would we do in MMH?
The small ones…
To warm up, here’s a series of great discussions about the small PEs – the ones where we should just stop before someone gets irradiated.
The Message from my pal Dr Senthi – ‘Prognosticate before you Investigate’….
http://www.emergucate.com/2013/09/16/senthi-v-weingart-on-pe/
This discussion originally posted on Casey Parkers excellent Blog -( http://broomedocs.com/). It’s well worth looking up this site for further info on this topic and other great posts.
(For some deep rummaging in to the history of PE, the evidence for heparin/anti-coagulation and general Boffinry you can spend a good 90mins listening to David Newman and Ashley Shreaves bang on at http://www.smartem.org/.
The podcast: http://www.smartem.org/podcasts/pulmonary-embolism-diagnosis-and-treatment )
Can we just send those small clots home? Can we? Well? Probably..
http://blog.ercast.org/pulmonary-embolus-outpatient-treatment/
PE in the ECG…
A great run through of the changes to look for from LITFL
http://lifeinthefastlane.com/ecg-library/pulmonaryembolism/
Some more ECG tips from Amal Mattu..
http://blog.ercast.org/st-elevation-its-not-just-for-mis-anymore/
Watch this great run through from him...
Now onto the big ones…
How to Treat those PEs, the big ones and the REALLY Big Ones..
EMCRIT gets amongst it with these podcast:
The many options for Clot management and how to decide who and what..
http://emcrit.org/podcasts/pulmonary-embolism-treatment-team/
This is a deeper delve into the topics in that post:
http://emcrit.org/podcasts/hemodynamic-management-massive-pulmonary-embolism-pe/
Here’s a slightly older podcast with Jeff ‘The PERC’ Cline and Scott. Very Digestible and easy listening…
http://emcrit.org/podcasts/fibrinolysis-in-pulmonary-embolism/
For more insights into the fluid strategies and management of massive PE and Treatment pearls, this post is well worth your consideration..
http://www.pulmcrit.org/2014/07/eight-pearls-for-crashing-patient-with.html
Probes and Jelly…
A great case and discussion on Massive PE on Ultrasound, by Matt and Mike.