August 2023

Subsegmental PE – Hold the Anticoagulation?

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Structured surveillance without anticoagulation of patients with isolated subsegmental pulmonary embolism (ssPE) rarely occurs in community practice. After applying CHEST guidelines, ~5% of patients with isolated subsegmental PE are eligible for surveillance.

Prevalence of and Eligibility for Surveillance Without Anticoagulation Among Adults With Lower-Risk Acute Subsegmental Pulmonary Embolism. JAMA Netw Open. 2023;6(8):e2326898. Published 2023 Aug 1. doi:10.1001/jamanetworkopen.2023.26898

New ACEP Clinical Policy on Mild TBI

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ACEP has issued an updated Clinical Policy to provide evidence-based guidelines for management of adult patients presenting to the ED with mild traumatic brain injury based on systematic review of available literature.

Clinical Policy: Critical Issues in Management of Adult Patients Presenting to the Emergency Department with Mild Traumatic Brain Injury. Ann Emerg Med. 2023 May; 81(5): e63-e105. doi: 10.1016/j.annemergmed.2023.01.014.

This Is BIG – New AAST Brain Injury Guidelines

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This article was a multi-institutional prospective validation of the American Association for Surgery of Trauma (AAST) Brain Injury Guidelines (BIG), which were developed to guide effective resource utilization for traumatic brain injury. The validation study demonstrated that this system was accurate and safe and that its implementation can reduce CT scan utilization and neurosurgical consultation.

Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28.

Dual Antiplatelets or Lytics for Minor Stroke?

Written by Alex Clark Spoon FeedIn minor acute ischemic stroke (AIS) patients presenting within 4.5 hours of onset, dual antiplatelet therapy (DAPT) is non-inferior to intravenous alteplase for excellent neurologic outcome at 90 days. Let me get this straight… DAPT is not, not, not worse than tPA?Current guidelines recommend thrombolytics for AIS patients presenting within …

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