Asymptomatic Hypertension

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.

Asymptomatic Hypertension Podcast

Asymptomatic HTN (Word Format)

Asymptomatic HTN (PDF)

Philosoraptor wants to know

asymptomatic HTN philo

Links from the podcast:

ACEP Clinical Policy on Asymptomatic HTN in the ED

HTN doesn’t cause headaches- editorial with relevant studies

Short Coats in EM by Dr. Lauren Westafer on Asymptomatic HTN

Home blood pressure monitors cause cancer?  Not really but Dr. Reuben Strayer has some great ideas on asymptomatic HTN as well

The highest recorded blood pressure I could find was…


PE Part 2 Show Notes Posted

Here are the show notes for PE Part 2- Risk Stratification and Treatment

PE Part 2 Show Notes (Word Format)

PE Part 2 Show Notes (PDF)


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.

PE Podcast Part 2

PE Part 2 Show Notes (Word Format)

PE Part 2 Show Notes (PDF)

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)


PE Part 1 Show Notes Posted

The show notes for PE Part 1 are posted and available here

PE Part 1 (Word Format)

PE Part 1 (PDF)


PE Part 1

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.

PE Part 1 Podcast

PE Part 1 Show Notes (Word Format)

PE Part 1 Show Notes (PDF)

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%)

PERC rule- original paper

PERC rule- EM Basic Essential Evidence Episode

Other PE decision rules (revised Geneva and Wells)- not as commonly used as PERC

ercast podcast on imaging for PE in pregnancy with Jeff Kline


Oxygen in COPD episode fixed

Hi everyone,

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.

Here’s the link for the podcast

Here’s the link to the original post

Sorry for the mixup- you stay classy, podcast listeners

Steve


Oxygen in COPD- followup

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.

Oxygen in COPD- followup

Here are some relevant references for further reading.

1. New, A.  Oxygen: kill or cure? Prehospital hyperoxia in the COPD patient.  Emerg Med J. 2006 February; 23(2): 144–146.

2. Austin MA et al. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: Randomised controlled trial. BMJ 2010 Oct 18; 341:c5462. 

3. Kilgannon JH, et al. Association Between Arterial Hyperoxia Following Resuscitation From Cardiac Arrest and In-Hospital Mortality. JAMA Vol 303, No 21, June 2, 2010;2165-2171. 

4. Cornet AD, Kooter AJ, Peters MJ, Smulders YM. The potential harm of oxygen therapy in medical emergencies. Crit Care. 2013;17(2):313.


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