The Right Ventricular Spiral of Death

The right ventricular spiral of death in PE is very real and very scary. We sometimes miss it, because we treat all resuscitations the same way and we shouldn’t. Here are two cases:CASE 1: A 35 yo woman presents to the ED with SOB, tachycardia, BP of 105/60, a high respiratory rate and sats of…

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Guidelines for the Diagnosis and Management of DVT and PE

This is a review of the updated guidelines on Diagnosis and Management of DVT and PE, which were released in March 2020 by the National Institute for Health and Care Excellence(NICE). They now incorporate the use of age adjusted D-dimers and the PERC(Pulmonary Embolism Rule-Out Criteria). They cover the management of different causes of thromboembolism…

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How to Read the CTPA

CTPA’s are sometimes quite confusing to read. A simple approach, based on differentiating the anatomy is the approach to take. Below Dr Kas takes us through the reading of the CTPA.

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Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

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Age-Adjusted D-dimer for ruling out pulmonary embolism

We use D-dimer in patients with a low probability of a pulmonary embolism, to rule out the condition and thus avoid imaging. The level of D-dimer rises with many conditions and also with age, thereby reducing it’s specificity for this condition. In a retrospective cohort study of D-dimer cut-offs, Ackerly et al(1)  compared three proposals for…

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Which Patients with Pulmonary Embolism should get Thrombolysis?

The diagnosis of pulmonary embolism(PE) is an almost common occurrence in the emergency department. The question of which patients to thrombolyse can be a difficult one to answer. Certainly there is consensus over patients with massive PEs needing thrombolysis. The same cannot be said for those patients with a submissive PE, because our greatest fear is…

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The ECG’s of Pulmonary Embolism

Let me start by saying that some pulmonary embolisms(PE)’s are obvious. In those, you don’t need pulmonary embolism ECG findings to make the diagnosis. I recently was shown an ECG and asked what the patient’s diagnosis was. I asked my colleague, what the patient presented with. He replied; “This is a 68 yo woman who…

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How Dangerous is Pulmonary Embolism?

How Dangerous is Pulmonary Embolism? The diagnosis and management of pulmonary embolism(PE), like most things in emergency medicine; it’s about risk stratification. In chest pain, the low risk patient is approached very differently to the high risk, ST elevation chest pain patient. It is exactly the same in PE. There is that group of patients…

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The ECG of Pulmonary Embolism

There are several distinct ECG patterns in pulmonary embolism A CASE A 36 yo male presents to the emergency department with sharp central chest pain and shortness of breath. He works as a truck driver. He has no past medical history, is on no medications and normally very well, with no significant family history. An ECG…

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