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.