PE Part 2- Risk stratification and treatment

This episode is part 2 of the PE podcast where we will discuss risk stratification and treatment of PE.  It’s important that we accurately quantify the amount of clot burden that the patient has to order the right treatment and admit them (or maybe even discharge them) to the right location.  We’ll talk about how to classify massive, sub-massive, and “non-massive” PEs and how to treat them. We’ll also briefly talk about emerging evidence for the expanding role of thrombolytics and outpatient treatment of PE.

PE Podcast Part 2

PE Part 2 Show Notes (Word Format)

PE Part 2 Show Notes (PDF)

Links mentioned during the podcast:

Cardiac ultrasound for diagnosing right heart strain/PE- from the Ultrasound Podcast (starts the PE section at 34:10)

TPA dose during cardiac arrest- from Brian Hayes at Academic Life in EM

Thrombolytics for submissive PE- from Dr. Salim Rezaie at Academic Life in EM

Outpatient management of PE- from the Skeptics Guide to Emergency Medicine (SGEM)


Tweeting Locally, Reaching Globally

The necessity of providing emergency care is not restricted to the world’s wealthiest countries. The lucky few living in settings with access to 24/7 emergency care, staffed by physicians educated in rigorous, structured settings, benefit from the resources disproportionately available. These clinicians have the support of their hospital physician education programs, may be funded for access to costly Continuing Medical Education, and belong to professional societies that provide further educational content. These issues are further exacerbated when publishers like Elsevier draw revenues of £2.1 billion and aggressively defend their profits with copyright crackdown lawsuits – further stifling the dissemination of medical knowledge.

How can the developing world – arguably in even greater need of support – bootstrap itself up without these resources?

That answer may present itself in a movement over the last few years to generate free, openly-accessible content. Entitled FOAM – Free Open Access Meducation – “Medical education for anyone, anywhere, anytime”, this movement spans the clinical spectrum. Frequently published by internationally-renowned expert, subjects range from core emergency medicine to advanced critical care, with all manner of knowledge translation in between.

A sampling of highlights:

  • The WikEM, a growing resource of practical point-of-care clinical knowledge.
  • EMCrit, critical care content and podcasts “bringing upstairs care downstairs”.
  • The Poison Review, critical appraisals on medical toxicology.
  • Life In the Fast Lane, aggregated Emergency Medicine education, upside-down.

Even commercial sites, such as eMedicine have valuable core content available in many specialties. However, care must be taken to evaluate each article for sources of bias, considering the revenue they derive from pharmaceutical sponsorship.

Unfortunately, much of this content is English language-only; Google Translate and other similar technologies ameliorate this barrier, but it remains an imperfect solution. Regardless, physicians in developing nations have access to an ever-increasing wealth of of experts – with nothing more than an internet connection.

Discover more through the most active social media platform, Twitter, using the #FOAMed hashtag.

Ryan Radecki

@emlitofnote

Associate Social Media Editor EMJ

 

Crisis, Crewmanship and CRM

Most ED folk are familiar with the CRM concept. It’s about teamwork, innit? And of course, we are all great at that. Go on – find someone in ED who says they are useless at teamwork! It would be like finding someone who says that they are absolutely rubbish in bed!

CRM stands for Crisis Risk Management. Or something. And it’s in a video about an air crash, where the air steward (who is a bit backward) doesn’t tell the chief pilot that he has just turned the engines off. The pilot is a cranky old fart who trained on biplanes. That’s called an “authority slope”.

You can do courses in CRM with SimMan. Just watch out when SimMan says he has crushing chest pain, because that’s when he’s about to have a cardiac arrest! Afterwards, they’ll ask you how you did, what went right, and what you could have done better. It’s a bit cringing really. Haven’t done one in years.

You know, this CRM thing is really a bit of a fad. Aside from air crashes in the 1970s, and fibrillating manikins, it doesn’t have much relevance to the real world. Does it?

The post Crisis, Crewmanship and CRM appeared first on LITFL.

Rakibinizin Stratejisini Öngörmek – Bölüm 1

Satranç gibi hamlelerin birbirini takip ettiği oyunlarda rakipler, karşıdakinin hamlesini görerek kendi hamlesini belirlemeye çalışır. Ardışık hamleli oyunlarda, her oyuncunun, geriye doğru akıl yürüterek kendisinin o sıradaki hamlesini öngörmesi gerekmektedir. Doğrusal bir düşünce zinciri vardır: “Eğer bunu yaparsam, öteki oyuncu şunu yapacak –ki bu durumda ben de şöyle karşılık vereceğim.” Bazı oyunlarda ise oyuncuların her ...

A nurse on coffee.

It is inhumane, in my opinion, to force people who have a genuine medical need for coffee to wait in line behind people who apparently view it as some kind of recreational activity – Dave Barry

When not at work, I wish my days rounded with an ambiance of slow, ritual caffination.

You see, working in the emergency department is distastefully instant.
You are simply not afforded the slightest space amongst the tachycardic catastrophies to let your lips simmer over molten-gold creme.
To pause and feel the weight of your favourite chipped clay mug cupped in your hands. Or perhaps porcelain. Or earthenware.
To lean in and feel the swirling warm steam feather your cheeks.

You can probably already guess that I am a bit of a coffee junkie. But far from a connoisseur.  I admit straight up that I like my cup strong and hot as sun-plasma, which is not really a great cup if you are knowledgeable in these things, as it dampens the delicate oils and ‘bakes’ out the flavour.

I lope over to the hospital coffee shop and impatiently queue up for a brew, standing in line for 10 minutes behind the towering orthopaedic registrar. Only to have him step up and order 9 cups for all his theatre buddies…no, actually make that 10.
And then turn to face down to me with a sorry about that grin that leaves me no other choice than to deliver a swift imaginary flying back-kick to his testicle bones.
With a screaming run up from way down the corridor near the oncology unit. To ensure compound fractures.

When I finally do return with my prize, I inevitably end up leaving it sitting half interrupted, just a few sips past foreplay, next to some pile of patient notes.
Whilst I, you know…..rush over to someone vomiting, or dying, or wanting me to make them a coffee or something.

So I leave my Styrofoam cup laying around to go cold…yet again.
Or to be spilt… expletively across a patients notes, or into a keyboard. Probably by a staff specialist or the nursing unit manager.

At work, for me at least, coffee is just Styrofoam, or perhaps those reusable cups that I buy from time to time to do my bit to save the planet.
Cups that always smell of plastic and stale milk ’cause I never wash the lids out properly…. and then inevitably leave them lying around only to be found several months later in a cardboard box on the tea-room table full of dirty Tupperware.
You know, the box with a sign written in red bold pen proclaiming that any items not claimed in the next week will be thrown out. Thrown out printed in capitals. With 3 exclamation marks.
The box that holds 11 other of my curd encrusted planet savers. That box.

But on my days off, coffee can be way more enjoyable.
Searching out new coffee shops provides a happy matrix of way-points to plot against any downtime adventures. Especially satisfying are those unexpectedly awesome coffees found in off-the-track, stumbled upon places.

I once spent a 3 week holiday dragging Kelly all over Japan in a desperate search for a good cup of coffee.
We totally had the most fantastic time and our search bumped us up against many helpful people.
But alas, the coffee sucked everywhere…. except for one Arabica-oasis in the centre of Tokyo.

In fact by the end of the trip I think I had completely detoxed from caffeine against my consent. I felt more relaxed. And light. My soul was re-perfused with the oceans of green tea I had been consuming. It was bad. Real bad.

Despite this green tea satori, arriving back in Sydney airport it was a mercy dash to the first coffee bar to order a strong, hot, flat white.
The bored looking girl behind the espresso machine cranked out a cappuccino. When I pointed out that I had in fact ordered a ‘flat’, she lifted the cup back from me, placed it down on the counter, picked up a knife and (to be fair, with quite a flourish) sliced the foam off before handing the cup back to me.
A decapitated cappuccino. Welcome home.

I have my favourite coffee haunts that I guard with the same measured vagueness you might get when asking a surfer about the best local break.

My personal secret way-points are cast wide.
There is an Autumn place in Leura, a small town in the Blue Mountains west of Sydney.
Spring coffee beside lake Wanaka on the south island of New Zealand.
Winter brewed in the heart of Melbourne. Summer on the Great Ocean Road.

And yes, I have my favourite places right here in Canberra. Give me a rainy afternoon, a comfy chair and a book. Life is good.

Im sure you will agree, great coffee is about far more than what is in the cup.

If you talk to true coffee experts they will talk about the 4 M’s that go together to make the perfect cup:
Macinazione is the correct grinding of a coffee blend. Having a good grinder is considered at least as important as having a quality expresso machine.
Miscela is the coffee blend. There are as many blends as there are adventures you can undertake searching for them.
Macchina is the espresso machine. Now don’t get me started here, some of these things are works of art. Ohh….shiny.
And finally the Mano. The skilled hand of the barista. I could tell you about my dreams of scantily clad, geeky, Swedish baristas…….
Ahem…..but I wont.

No, coffee is more than even the sum of these parts.
It is also about infusing place, and person. The ambiance of your surrounds, the quality of your companionship, and the tempo of your day.