The shadow of the long-term sequelae of submassive pulmonary emboli has stalked the hearts and minds of Emergency Physicians. The use of thrombolytics to prevent these ramification has previously been supported primarily with surrogate data, physiological reasoning and communal anecdotal experience. Thrombolytics for submassive pulmonary emboli have failed to demonstrate an … [Read more...]
EM Nerd-An Addendum to the Case of the Incidental Bystander Part II
Recently I wrote a post discussing overdiagnosis in the workup for pulmonary embolism (PE). In it we discussed a recently published paper, the RESPECT-ED trial. Shortly after posting I was contacted by the lead author, Dr. David Mountain, with a number of comments and concerns on how the trial was represented. I have included it here as it is a wonderful assessment. Dear … [Read more...]
EM Nerd-The Case of the Incidental Bystander Part II
The existence of overdiagnosis in the pursuit of pulmonary embolism (PE) is undeniable. But the burden of clinically insignificant PEs diagnosed by our current hypersensitive, zero-miss culture is less apparent. The authors of a recent article ironically entitled RESPECT-ED, attempted to quantify the role in which overdiagnosis plays in the current incidence of PE.Recently … [Read more...]
EM Nerd-The Case of the Incidental Bystander
It is quite uncommon that while reading the results of a clinical trial one feels the universal gasp of sorrow released from the hearts and minds of Emergency Physicians worldwide. Maybe it was my own personal anguish at the realization of the disastrous consequences the results of a recent trial published in the NEJM will have on the practice of Emergency Medicine, but I am … [Read more...]
Two EKG patterns of pulmonary embolism which mimic MI
Introduction with a case 0 A 45-year old man presented to the hospital with chest pain and dyspnea. His troponin was positive, and EKG showed T-wave inversions in the inferior leads and V1-V4. He was pale, diaphoretic, tachycardic, and borderline hypotensive with a systolic blood pressure ranging from 85-110mm. He was taken urgently for cardiac catheterization, which … [Read more...]
Hi, my name is Scott Weingart.