Apple Podcasts , Spotify, Listen Here

Guidelines have recommended outpatient management for patients with low-risk pulmonary embolism (PE) for many years. Despite this, few patients in the US diagnosed with acute PE are discharged from the Emergency Department (Westafer et al). Little is known about the course of patients managed exclusively or primarily in the outpatient setting. In this study, Vinson and colleagues describe the nature and course of patients diagnosed with pulmonary embolism in the primary care setting.

Vinson DR, Hofmann ER, Johnson EJ, Rangarajan S, Huang J, Isaacs DJ, Shan J, Wallace KL, Rauchwerger AS, Reed ME, Mark DG; PEPC Investigators of the KP CREST Network. Management and Outcomes of Adults Diagnosed with Acute Pulmonary Embolism in Primary Care: Community-Based Retrospective Cohort Study. J Gen Intern Med. 2022 Jan 12. doi: 10.1007/s11606-021-07289-0. Epub ahead of print. PMID: 35020167.

Apple Podcasts , Spotify, Listen Here

The diagnostic algorithm for pulmonary embolism (PE) has evolved over the past few years to include probability or risk-adjusted D-dimer. The YEARS algorithm includes an elevated D-dimer threshold for some risk groups and has been found to be safe and reduce imaging in several studies, including in pregnant patients. Now, this multicenter trial by Freund et al evaluates the use of YEARS and age-adjusted D-dimer compared with an age-adjusted approach alone.

Freund Y, Chauvin A, Jimenez S, Philippon AL, Curac S, Fémy F, Gorlicki J, Chouihed T, Goulet H, Montassier E, Dumont M, Lozano Polo L, Le Borgne P, Khellaf M, Bouzid D, Raynal PA, Abdessaied N, Laribi S, Guenezan J, Ganansia O, Bloom B, Miró O, Cachanado M, Simon T. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA. 2021 Dec 7;326(21):2141-2149. doi: 10.1001/jama.2021.20750. PMID: 34874418; PMCID: PMC8652602.

Apple Podcasts , Spotify, Listen Here

A single-center randomized trial in 2018 by Driver et al found an incredible 98% first-pass success for endotracheal intubation in the group randomized to a structured bougie-first approach, compared with 87% in those randomized to stylet. In this podcast, we review a multi-center study by Driver et al examining bougie vs stylet in a wider array of emergency departments and intensive care units.

Apple Podcasts , Spotify, Listen Here

Subsegmental pulmonary embolism (SSPE) is a controversial entity as they have uncertain clinical significance. As a result, the Chest and ACEP guidelines state that a very select group of patients with isolated SSPE and no deep vein thrombosis may be managed with surveillance rather than anticoagulation. In this podcast, we review SSPE and a new prospective study by Le Gal and colleagues evaluating outcomes after withholding anticoagulation in patients with subsegmental pulmonary embolism (SSPE).

Apple Podcasts , Spotify, Listen Here

On November 2, 2021, the US CDC Advisory Council on Immunization Practices recommended the Pfizer-BioNTech mRNA covid-19 vaccine for children ages 5-11. In this podcast we review the data in the Pfizer briefing document to the FDA as well as that presented at the ACIP meeting.

References for myocarditis: Witberg et al NEJM Oct 2021, Mevorach et al. NEJM Oct 2021

updated 11/1/2021

Apple Podcasts , Spotify, Listen Here

The American Academy of Pediatrics (AAP) released new clinical practice guidelines in August 2021 on the evaluation and management of well-appearing febrile infants ages 8-60 days old (Pantell et al).

Apple Podcasts , Spotify, Listen Here

In this podcast, we review pulmonary embolism (PE) risk stratification and dive into the use of right ventricular dysfunction as a predictor of mortality. We highlight a patient-level meta-analysis by Becattini et al and discuss guidelines on PE risk stratification.

Apple Podcasts , Spotify, Listen Here

In this podcast, we summarize a practice-changing article of 2021 that addresses awareness during paralysis, Pappal et al in Annals of Emergency Medicine.

Apple Podcasts , Spotify, Listen Here

We review a recent paper by Kilaru et al on pharmacy fills by ED patients for naloxone after an opioid-related ED visit. We also discuss harm reduction and the reasons this is important. For more on harm reduction, including patient education materials, see this.