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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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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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Thromboembolism in the Post-Partum Period

Patients presenting to the Emergency Department with signs or symptoms which might be indicative of a DVT or  pulmonary embolism in the postpartum period are treated with increased suspicion because there is in fact an increased risk. HOW LONG DOES THIS INCREASED RISK LAST FOR? The postpartum period is defined as 6 weeks following delivery. …

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The ECG’s of Syncope

I’m not sure about you, but I seem to be seeing more patients with syncope than ever before. This year at EMCORE, I spent over an hour going into the ECG’s of syncope. Syncope is difficult because it is a symptom, not a condition and it’s up to us to find the cause. My approach…

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