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Latest & greatest articles for pulmonary embolism
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Patent Foramen Ovale and Ischemic Stroke in Patients With PulmonaryEmbolism: A Prospective Cohort Study. Pulmonaryembolism (PE) is associated with increased risk for ischemic stroke, but the underlying mechanism remains unclear. The authors hypothesized that paradoxical embolism through patent foramen ovale (PFO) should be the main mechanism.To determine the frequency of recent ischemic stroke in patients with symptomatic PE according to whether PFO was detected.Prospective cohort study (...) was more frequent in the PFO group than in the non-PFO group (9 of 42 patients [21.4%] vs. 15 of 273 patients [5.5%]; difference in proportions, 15.9 percentage points [95% CI, 4.7 to 30.7 percentage points]).Because of inconclusive contrast TTE or MRI, 46 patients were excluded from analysis.Frequency of recent ischemic stroke in patients with symptomatic PE was higher in patients with PFO than in those without PFO. This finding supports the hypothesis that paradoxical embolism is an important
A novel electrocardiographic parameter for diagnosis of acute pulmonaryembolism: RS time: RS time in acute pulmonaryembolismPulmonaryembolism (PE) is one of the leading causes of cardiovascular mortality worldwide. Electrocardiography (ECG) may provide useful information for patients with acute PE. In this study, we aimed to investigate the diagnostic value of the QRS duration and RS time in inferolateral leads in patients admitted to the emergency department, and pre-diagnosed with acute (...) PE.We retrospectively enrolled 136 consecutive patients, admitted to the emergency department, pre-diagnosed with the clinical suspicion of acute PE, and underwent computerized tomographic pulmonary angiography (CTPA) to confirm the PE diagnosis. The study subjects were divided into two groups according to the presence or absence of PE, and the independent predictors of PE were investigated.Sixty-eight patients (50%) had PE. Patients with PE had a longer RS time. Among the ECG parameters, only RS
Outpatient versus inpatient treatment for acute pulmonaryembolism. Pulmonaryembolism (PE) is a common life-threatening cardiovascular condition, with an incidence of 23 to 69 new cases per 100,000 people each year. For selected low-risk patients with acute PE, outpatient treatment might provide several advantages over traditional inpatient treatment, such as reduction of hospitalisations, substantial cost savings, and improvements in health-related quality of life. This is an update
Rapid blood test helps exclude pulmonaryembolism for low risk patients Rapid blood test helps exclude pulmonaryembolism for low risk patients Discover Portal Discover Portal Rapid blood test helps exclude pulmonaryembolism for low risk patients Published on 25 October 2016 doi: An inexpensive blood test can help quickly rule out pulmonaryembolism for low risk patients attending hospital outpatient or emergency departments, especially in people with early symptoms. This review looked (...) diagnostic imaging. Overall a change in the management pathway for suspected pulmonaryembolism (PE) have potential to be cost saving and provide better care. Commissioners, will be interested in the overall pathway costs but unfortunately these were not researched here. Share your views on the research. Why was this study needed? In the UK, 47,734 cases of PE were reported between 2014 and 2015. Emergency admissions for PE increased by 30% between 2008 and 2012. A pulmonaryembolism is a blockage
Inhaled nitric oxide to treat intermediate risk pulmonaryembolism: A multicenter randomized controlled trial. To test the hypothesis that adjunctive inhaled NO would improve RV function and viability in acute PE.This was a randomized, placebo-controlled, double blind trial conducted at four academic hospitals. Eligible patients had acute PE without systemic arterial hypotension but had RV dysfunction and a treatment plan of standard anticoagulation. Subjects received either oxygen plus
Efficacy of rivaroxaban for pulmonaryembolism (PE): an updated systematic review protocol of randomized controlled trial Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any
The clinical net benefit of thrombolysis in the management of submassive pulmonaryembolism: systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any
Thrombolytic therapy for pulmonaryembolism. Thrombolytic therapy is usually reserved for patients with clinically serious or massive pulmonaryembolism (PE). Evidence suggests that thrombolytic agents may dissolve blood clots more rapidly than heparin and may reduce the death rate associated with PE. However, there are still concerns about the possible risk of adverse effects of thrombolytic therapy, such as major or minor haemorrhage. This is the third update of the Cochrane review first (...) of treatment. None of the included studies reported on post-thrombotic syndrome or compared the costs of different treatments.Low-quality evidence suggests that thrombolytics reduce death following acute pulmonaryembolism compared with heparin. The included studies used a variety of thrombolytic drugs. Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause major and minor haemorrhagic events and stroke. More high-quality, blinded randomised controlled trials
Increasing Safe Outpatient Management of Emergency Department Patients With PulmonaryEmbolism: A Controlled Pragmatic Trial. Many low-risk patients with acute pulmonaryembolism (PE) in the emergency department (ED) are eligible for outpatient care but are hospitalized nonetheless. One impediment to home discharge is the difficulty of identifying which patients can safely forgo hospitalization.To evaluate the effect of an integrated electronic clinical decision support system (CDSS
Can Echocardiography Be Used to Diagnose PulmonaryEmbolism at the Bedside? TAKE-HOME MESSAGE When pretest probability for pulmonaryembolism is high, abnormalities in right ventricular function detected on echocardiogram strongly support the diagnosis; however, a normal echocardiogram cannot be used to rule out pulmonaryembolism. Can Echocardiography Be Used to Diagnose PulmonaryEmbolism at the Bedside? EBEM Commentators Robert R. Ehrman, MD Mark J. Favot, MD Department of Emergency Medicine (...) by cardiologists, and 1 unclear)andatthepointofcarein 7 studies; 7 studies were con- ducted solely in the ED. The authors identi?ed 9 unique echocardiographic signs of pulmo- nary embolism, as well as the unde?ned ?nding of “right-sided heart strain.” Overall, the signs of pulmonaryembolism were moder- atelyspeci?c(range61%to99%)but poorly sensitive (range 5% to 80%). Test characteristics were slightly improved when echocardiograms were performed by physicians. In the pooled and subgroup analyses, McConnell’s
What Is the Best Imaging Study to Rule Out PulmonaryEmbolism in Pregnancy? (SRS diagnosis) What Is the Best Imaging Study to Rule Out PulmonaryEmbolism in Pregnancy? TAKE-HOME MESSAGE Both computed tomography (CT) pulmonary angiography and lung scintigraphy (ie, ventilation-perfusion scan) are appropriate imaging options for exclusion of pulmonaryembolism during pregnancy. EBEM Commentators Latha Ganti, MD, MBA David Lebowitz, MD Department of Clinical Sciences University of Central Florida (...) College of Medicine Orlando, FL Jestin N. Carlson, MD, MS, and Alan Jones, MD, serve as editors of the SRS series. Editor’s Note: This is a clinical synopsis, a regular feature of the Annals’ Systematic Review Snapshot (SRS) series. The source for this systematic review snapshot is: van Mens TE, Scheres LJJ, de Jong PG, et al. Imaging for theexclusion of pulmonaryembolism in pregnancy. Cochrane Database Syst Rev. 2017;1:CD011053. Results Summary of results for the diagnosis of pulmonaryembolism
Accuracy and Interobserver Reliability of the Simplified PulmonaryEmbolism Severity Index Versus the Hestia Criteria for Patients With PulmonaryEmbolism The objective was to assess and compare the accuracy and interobserver reliability of the simplified PulmonaryEmbolism Severity Index (sPESI) and the Hestia criteria for predicting short-term mortality in patients with pulmonaryembolism (PE).This prospective cohort study evaluated consecutive eligible adults with PE diagnosed
Diagnosis of PulmonaryEmbolism During Pregnancy: A Multicenter Prospective Management Outcome Study. Data on the optimal diagnostic management of pregnant women with suspected pulmonaryembolism (PE) are limited, and guidelines provide inconsistent recommendations on use of diagnostic tests.To prospectively validate a diagnostic strategy in pregnant women with suspected PE.Multicenter, multinational, prospective diagnostic management outcome study involving pretest clinical probability (...) assessment, high-sensitivity D-dimer testing, bilateral lower limb compression ultrasonography (CUS), and computed tomography pulmonary angiography (CTPA). (ClinicalTrials.gov: NCT00740454).11 centers in France and Switzerland between August 2008 and July 2016.Pregnant women with clinically suspected PE in emergency departments.Pulmonary embolism was excluded in patients with a low or intermediate pretest clinical probability and a negative D-dimer result. All others underwent lower limb CUS
BTS Guidelines for the outpatient management of pulmonaryembolism Thorax An international journal of RESPIRATORY MEDICINE thorax.bmj.com July 2018 Volume 73 Supplement 2 BRITISH THORACIC SOCIETY GUIDELINE FOR THE INITIAL OUTPATIENT MANAGEMENT OF PULMONARYEMBOLISM British Thoracic Society Outpatient Management of PulmonaryEmbolism Guideline Development GroupHealthcare providers need to use clinical judgement, knowledge and expertise when deciding whether it is appropriate to apply (...) recommendations for the management of patients. The recommendations cited here are a guide and may not be appropriate for use in all situations. The guidance provided does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.BTS Outpatient Management of PulmonaryEmbolism Guideline Development Group Dr Luke Howard (Chair), Dr Steve Barden, Dr Robin Condliffe, Dr Vincent
Prevalence of pulmonaryembolism in syncope Emergency Medicine > Journal Club > Archive > March 2018 Toggle navigation March 2018 2018 Prevalence of PE in Syncope Vignette You're working a TCC shift with Dr. Cohn, sitting right beside you. He's drinking a Diet Coke, having not offered you one. You decide to go see your next patient, a 78 year old female, complaining of "feeling woozy". she endorses syncope, shortness of breath, and leg pain. She is saturating 89% on room air, tachycardic to 104 (...) , and BP 117/76. She has many other reasons other than a pulmonaryembolism to be feeling this way, but the syncope has you thinking. You remember reading an article that was all the rage a few months ago regarding syncope as a presenting complaint for PE. It was fake news, you said. So vague. But here you are. You've got a minute, and Dr. Cohn by your side. You search the literature and gently fall into a rabbit hole... PICO Question Population: Adult patients presenting to the ED with syncope
Safety of the Combination of PERC and YEARS Rules in Patients With Low Clinical Probability of PulmonaryEmbolism: A Retrospective Analysis of Two Large European Cohorts This study aimed to determine the failure rate of a combination of the PERC and the YEARS rules for the diagnosis of pulmonaryembolism (PE) in the emergency department (ED).We performed a retrospective analysis of two European cohorts of emergency patients with low gestalt clinical probability of PE (PROPER and PERCEPIC). All (...) patients we included were managed using a conventional strategy (D-dimer test, followed, if positive, by computed tomographic pulmonary angiogram (CTPA). We tested a diagnostic strategy that combined PERC and YEARS to rule out PE. The primary endpoint was a thromboembolic event diagnosed in the ED or at 3-months follow-up. Secondary endpoints included a thromboembolic event at baseline in the ED and a CTPA in the ED. Ninety-five percent confidence intervals (CIs) of proportions were calculated
Blood and Clots Series: Diagnosing pulmonaryembolism in pregnancy Blood and Clots Series: Diagnosing pulmonaryembolism in pregnancy - CanadiEM Blood and Clots Series: Diagnosing pulmonaryembolism in pregnancy In , by Eric Tseng August 13, 2018 All the content from the Blood & Clots series can be found . CanMEDS Roles addressed: Medical Expert Case Description A pregnant 32 year old female presents to the ER with chest pain. She is 33 weeks gestational age, and this is her third pregnancy (...) air, and respiratory rate is 22. Her weight is 80 kg. Cardiac and respiratory examinations are unremarkable. She has no leg swelling or erythema. Her abdomen demonstrates a gravid uterus. Her bloodwork demonstrates a Hb of 98, WBC 5.0, platelets 156, creatinine 80. D-Dimer is 1,080. Her chest x-ray is unremarkable, with no effusions or consolidation. Does she have a pulmonaryembolism (PE)? Main Text Question 1: How helpful are clinical prediction rules and D-Dimer for ruling in or ruling out
Prediction of short-term prognosis in elderly patients with acute pulmonaryembolism: validation of the RIETE score Essentials The RIETE score was derived to predict 10-day adverse outcomes in acute pulmonaryembolism (PE). We externally validated the RIETE score in a prospective cohort of patients with PE. The RIETE score classified fewer patients as low-risk than currently recommended scores. The RIETE score was not superior to other scores in predicting 10-day adverse outcomes.Introduction (...) The Registro Informatizado de la Enfermedad TromboEmbolica (RIETE) score was derived to identify patients with pulmonaryembolism (PE) at low risk of overall complications. Objective To externally validate the RIETE score and compare its prognostic performance with the PulmonaryEmbolism Severity Index (PESI), its simplified version (sPESI) and the Geneva Prognostic Score (GPS). Methods In a prospective multicenter cohort, we studied 687 elderly patients with acute PE. The primary outcome was 10-day
Evaluation of the pulmonaryembolism rule out criteria (PERC rule) in children evaluated for suspected pulmonaryembolism The pulmonaryembolism rule out criteria (PERC) reliably predicts a low probability of PE in adults. We examine the diagnostic accuracy of the objective components of the PERC rule in children previously tested for PE.Children aged 5-17 who had a D-dimer or pulmonary vascular imaging ordered from 2004 to 2014 in a large multicenter hospital network were identified by query