Bubble Time – A New, Simple Way to Detect RV Dysfunction
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By agitating and injecting a saline flush into an IV catheter, right ventricular (RV) dysfunction was identified when bubbles were cleared from the RV at a time of ≥ 40 seconds with high sensitivity. It was ruled out as well with good specificity, with a bubble time < 40 seconds.
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Right Ventricular "Bubble Time" to Identify Patients With Right Ventricular Dysfunction. Ann Emerg Med. 2024 Aug;84(2):182-194. doi: 10.1016/j.annemergmed.2024.02.005. Epub 2024 Apr 10. PMID: 38597847.
How to Care for Critically Ill PE Patients
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Anticoagulation is the cornerstone of managing acute pulmonary embolism (PE), but initial management strategies in the intensive care unit (ICU) for sicker patients* with acute PE lack consensus guidelines. This reviews the available evidence and provides guidance.
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Management Strategies for Acute Pulmonary Embolism in the Intensive Care Unit. Chest. 2024 Jun 1:S0012-3692(24)00675-5. doi: 10.1016/j.chest.2024.04.032. Online ahead of print. PMID: 38830402
Why So Much UFH for Acute PE? Can We Just Stop…
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This retrospective study found increased use of unfractionated heparin (UFH) relative to low-molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) over time, despite guidelines recommending LMWH or DOACs as first-line treatment for most patients with acute pulmonary embolism (PE).
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Trends in Initial Anticoagulation Among US Patients Hospitalized With Acute Pulmonary Embolism 2011-2020. Ann Emerg Med. 2024 Jun 18:S0196-0644(24)00277-4. doi: 10.1016/j.annemergmed.2024.05.009. PMID: 38888528.
No PERC, Wells, Geneva – Just D-Dimers for Everyone?
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A “D-dimer only” pathway in patients with suspected pulmonary embolism (PE) was safely used to determine need for imaging without clinical decision rules, but there are some concerns with this approach.
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Implementation, Clinical Benefit and Safety of a D-Dimer-Focused Pulmonary Embolism Testing Pathway in the Emergency Department. Ann Emerg Med. 2024 Apr 23:S0196-0644(24)00156-2. doi: 10.1016/j.annemergmed.2024.03.010. Epub ahead of print. PMID: 38661619.
Oxygen for Intermediate Risk PE – Even Without Hypoxemia?
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Utilizing oxygen, rather than room air, for patients with intermediate-risk acute PE may be helpful even if patients are not hypoxemic. We’ll need a study (but not this one), for further information.
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Oxygen Therapy in Patients With Intermediate-Risk Acute Pulmonary Embolism: A Randomized Trial. Chest. 2024;165(3):673-681. PMID: 37717936
Everything You Need to Know About Managing High-Risk PE…Mostly
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One third of eligible patients with high-risk pulmonary embolism (PE) receive systemic thrombolysis (ST) despite demonstrated mortality benefit. This review provides a comprehensive overview of current evidence on assessment and management of high-risk PE, with emphasis on reperfusion therapies.
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Rouleau SG, Casey SD, Kabrhel C, Vinson DR, Long B. Management of high-risk pulmonary embolism in the emergency department: A narrative review. Am J Emerg Med. Published online February 3, 2024. doi:10.1016/j.ajem.2024.01.039
Why Are More PE Patients Dying?
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Mortality in patients with high-risk pulmonary embolism (PE) in the United States increased over the last decade. Surprised? Here’s why this might be true, and what we should do about it.
Mortality of High-Risk PE Is, Well…High
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A prospective study by the PERT Consortium found an in-hospital mortality rate of 20% in patients with high-risk PE. 41.9% of patients with high-risk PE were treated with advanced therapies (systemic thrombolytics, catheter-directed thrombolysis or embolectomy, surgical embolectomy, ECMO).
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Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol. 2024;83(1):35-43. doi:10.1016/j.jacc.2023.10.026
FLAME Massive PE Study – FlowTriever for Intravascular Thrombectomy
Please take a moment to read about some exciting upgrades (CME, Amal Mattu, new website!!) and pricing changes with JournalFeed. I don't want anyone to be caught off guard. I also don't want anyone to let cost be a barrier. So, please read it when you can. ~Clay Smith
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In this non-randomized prospective trial, patients with massive pulmonary embolism who were treated with the intravascular FlowTriever thrombectomy device had improved outcomes compared to those treated with other therapies.
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Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study. Circ Cardiovasc Interv. 2023;16(10):e013406.
NSAIDs + OCPs = More VTEs?
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This Danish nationwide cohort study found that in reproductive-age women, NSAID use alone increased the risk of venous thromboembolism (VTE). The magnitude of risk was compounded by concomitant use of hormonal contraception.
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Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ 2023; 382 :e074450 doi:10.1136/bmj-2022-074450.