Podcast #320: PE in Pregnancy

Podcast #320: PE in Pregnancy

Author: Don Stader, M.D.

Educational Pearls:

  • Pulmonary embolism is one of the leading causes of maternal mortality.
  • There is disagreement among different medical societies about the value of D-dimer as a screening modality. If you use it, consider the rational D-dimer approach whereby you add 250 to your cut-off for every trimester.
  • A useful screening modality is an ultrasound of bilateral lower extremities looking for DVT.
  • Keep in mind, both a V/Q scan and CT scan have a significant amount of radiation. CTA is probably the right diagnostic test (less radiation than CT w&w/o).
  • Always use the shared decision-making model and clinical acumen to choose your tests.

References:

Leung AN, et. al. (2011). An official American Thoracic Society/Society of Thoracic Radiology clinical practice guideline: evaluation of suspected pulmonary embolism in pregnancy. American Journal of Respiratory and Critical Care Medicine. 184(10):1200-8

Polak JF, Wilkinson DL. (1991). Ultrasonographic diagnosis of symptomatic deep venous thrombosis in pregnancy. American Journal of Obstetrics and Gynecology. 165(3):625-9.

Sachs BP, et. al. (1987). Maternal mortality in Massachusetts. Trends and prevention. New England Journal of Medicine. 316(11):667-72.

Jaksot(1146)

Podcast # 481: Medical Errors and Cognitive Bias

Podcast # 481: Medical Errors and Cognitive Bias

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Podcast # 480: Inhalant Abuse

Podcast # 480: Inhalant Abuse

Author: Sam Killian, MD Educational Pearls: Abuse occurs by breathing in volatile substances such as solvents, glues, paints, butane, and propane Inhalants are generally depressants Estimated that 10...

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Podcast # 479: Clots and Pregnancy

Podcast # 479: Clots and Pregnancy

Author: Nick Hatch, MD Educational Pearls: Pregnancy is a hypercoagulable state, which predisposes women to venous thromboembolism, but also elevates levels of circulating d-dimer A recent study eva...

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Podcast # 478: Psychedelics and Depression

Podcast # 478: Psychedelics and Depression

Author: Chris Holmes, MD Educational Pearls: Hallucinogenic drugs have been in use since ancient times for both medical and recreational purposes Ayahausca is an ancient psychedelic with origins in B...

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Podcast # 477: Postpolypectomy Electrocoagulation Syndrome

Podcast # 477: Postpolypectomy Electrocoagulation Syndrome

Author: Nick Hatch, MD Educational Pearls: Postpolypectomy electrocoagulation syndrome (PES) is a rare complication of polypectomy and electrocautery during colonoscopy Occurs when cautery causes tr...

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Podcast # 476: Evidence for Patient Satisfaction

Podcast # 476: Evidence for Patient Satisfaction

Author: Dylan Luyten, MD Educational Pearls: Actual wait times are weakly correlated to patient satisfaction but the difference between perceived/expected wait times and actual wait times is strongly...

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Podcast # 475: Orthostatic Vital Signs and Syncope

Podcast # 475: Orthostatic Vital Signs and Syncope

Author: Michael Hunt, MD Educational Pearls: A recent study evaluated the relationship between abnormal orthostatic vital signs and serious outcomes within 30 days in patients over 60 presenting to t...

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Podcast # 474: Obesity Hypoventilation Syndrome

Podcast # 474: Obesity Hypoventilation Syndrome

Author: Peter Bakes, MD Educational Pearls: The differential diagnosis for pedal edema includes issues in the heart, kidney, and liver Obesity hypoventilation syndrome (OHS) is an important and commo...

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