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

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…

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)

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)

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

PE Part 1 (Word Format)

PE Part 1 (PDF)

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