The patient’s blood pressure is 190/80 but they feel fine…how do we treat these patients in the ED? Labs? EKG? BP meds? Admission???…but they are here for an ankle sprain! Asymptomatic hypertension is a challenging complaint to deal with in the ED because of so many conflicting opinions and worries but it doesn’t have to be difficult. In this episode, we’ll discuss a systematic and rational way to evaluate patients with asymptomatic HTN, do limited and targeting testing, and get them the right followup while calming the patient’s fears and avoiding harm.
Philosoraptor wants to know
Links from the podcast:
HTN doesn’t cause headaches- editorial with relevant studies
Home blood pressure monitors cause cancer? Not really but Dr. Reuben Strayer has some great ideas on asymptomatic HTN as well
Here are the show notes for PE Part 2- Risk Stratification and Treatment
This episode is part 2 of the PE podcast where we will discuss risk stratification and treatment of PE. It’s important that we accurately quantify the amount of clot burden that the patient has to order the right treatment and admit them (or maybe even discharge them) to the right location. We’ll talk about how to classify massive, sub-massive, and “non-massive” PEs and how to treat them. We’ll also briefly talk about emerging evidence for the expanding role of thrombolytics and outpatient treatment of PE.
Links mentioned during the podcast:
Cardiac ultrasound for diagnosing right heart strain/PE- from the Ultrasound Podcast (starts the PE section at 34:10)
TPA dose during cardiac arrest- from Brian Hayes at Academic Life in EM
Thrombolytics for submissive PE- from Dr. Salim Rezaie at Academic Life in EM
Outpatient management of PE- from the Skeptics Guide to Emergency Medicine (SGEM)
The show notes for PE Part 1 are posted and available here
This episode has been a long time in the making- presenting Pulmonary Embolism, part 1. PE is a deadly diagnose that we frequently have to consider in the ED. The presentations can be very varied but we need to know how to work up this disease while avoid unnecessary testing and harm to our patients. In part 1, we will discuss risk factors for PE, symptoms that should make you suspicious for PE, and how to order the correct labs and imaging to diagnose this serious condition.
EM Trends- a new FOAM blog on “what’s trending in EM”- great reviews of current literature
Links mentioned in the podcast:
Symptoms associated with PE- large prospective multi-center study (2.9% hemoptysis, 47% chest pain, 79% Shortness of breath)
PE diagnostic accuracy with increasing clinical experience (Accuracy for EM-1- 71%, EM 2-3 75%, EM 4 and attendings- 78%)
I just fixed the issue with the latest episode- a followup to the COPD podcast discussing the use of oxygen in COPD patients. You will likely need to delete the previous podcast from your iTunes/RSS feed and download the podcast again.
Sorry for the mixup- you stay classy, podcast listeners
The last podcast on COPD led to some great discussion online about the use of oxygen in patients with COPD. To address this, Drs. Tim Peck and Colby Redfield are back with a quick summary to clarify how to best use oxygen in patients with COPD. There’s also another cameo by the one and only Dr. Peter Rosen on how to succeed in emergency medicine.
Here’s the big points:
-Don’t hesitate to give high flow oxygen to hypoxic patients with shortness of breath- especially in the first 30-60 minutes of the resuscitation.
-After the patient has stabilized- give enough oxygen via nasal cannula (or lower flow face mask) to titrate their pulse ox between 88 and 92%. DO NOT leave patients with COPD on high flow oxygen for long periods of time.
Here are some relevant references for further reading.