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FOAMcast brings you pearls from conferences we attend and presently it’s the American College of Emergency Physicians annual meeting, ACEP15 in Boston.

Jeremy Hoffman and Rick Bukata summarize recent, relevant literature each year (recently known as #hofkata).  This year, our top three favorite

A top 5 list for emergency medicine: a pilot project to improve the value of emergency care.  Schuur et al. JAMA Internal Medicine. 2014.

  • Just say NO to:
    • CTs for trauma patients who are negative using the NEXUS and Canadian tools for cervical spine injuries.
    • CT for ruling out PE without some sort of risk stratification.
    • MRI for Low back pain w/o red flags.
    • Head CT in with mild TBI who do not meet criteria using the New Orleans OR Canadian Head CT tools.
    • Routine coagulation profile (unless they have a known coagulopathy or are hemorrhaging)

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

The effect of malpractice reform on emergency department care.  Moskow et al.   N Engl J Med. 2015 Jan 8;372(2):192.

Dr. Jeff Kline (@klinelab) spoke on pulmonary embolism.

  • High Risk PE? Consider lysis (this is controversial, we are simply reporting Dr. Kline’s talk)
    • Size and location. Massive and proximal= bad
    • SBP <90 for more than 15 min OR 40mmHg drop from baseline
    • Signs of RV strain – echocardiography showing RV dilation OR hypokinesis?
    • Elevated troponin or BNP
    • ECG findings suggestive of cardiac strain: sinus tachycardia, incomplete right bundle branch block, complete right bundle branch block, T-wave inversion in leads V1 – V4.
  • Kline also participated in a knowledge translation workshop where he argued that sub-segmental PEs, without DVT on ultrasound, are NOT a real thing.  This is controversial but he also argued that treating these is associated with harm [Carrier et al]

 

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