Podcast #249: D-Dimer

Podcast #249: D-Dimer

Author: Michael Hunt, M.D.

Educational Pearls

  • In the recent YEARS study, investigators checked every patient with suspicion for PE with a D-dimer, using a modified Wells score for risk stratification. The goal of the study was to show that CT scan usage could safely reduced using this screening method.
  • The Wells Criteria measures they used to stratify risk were: PE mostly likely dx, hemoptysis, and evidence of DVT. If the d-dimer was 1, but the patient had none of the Wells criteria, the patient did not get a CT. If the patient had any of the criteria, but the d-dimer was only 0.5, the patient did not get a CT scan.
  • The investigators reduced CT usage by 14% using the new criteria, with no significant increase in morbidity and mortality.

References: van der Hulle et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. The Lancet. 2017

Episoder(1146)

Podcast #351: Indications for AICD

Podcast #351: Indications for AICD

Author: Pete Bakes, MD Educational Pearls: AICD: Automated Implantable Cardioverter-Defibrillator. Can be placed for secondary prevention of cardiac arrest (i.e. history of cardiac arrest not fr...

11 Jul 20184min

Podcast # 350: Pressors and Ischemia

Podcast # 350: Pressors and Ischemia

Author: Nick Hatch, MD. Educational Pearls: A common concern using vasopressors is the risk of digital and mesenteric ischemia. The absolute risk of digital ischemia and/or mesenteric ischemia is...

9 Jul 20183min

Podcast # 349: Fat Emboli

Podcast # 349: Fat Emboli

Author: Sue Chilton, MD Educational Pearls: Triad of fat emboli syndrome is a petechial rash, AMS, and respiratory distress. Petechiae usually start in the axilla. 90% of patients with long bon...

4 Jul 20183min

Podcast # 348: Steakhouse Syndrome

Podcast # 348: Steakhouse Syndrome

Author: Don Stader, MD Educational Pearls: Steakhouse syndrome is an impacted esophageal food bolus. Occurs because they have an esophageal stricture (schatzki ring, scarring, esophagitis). Cla...

2 Jul 20183min

Podcast # 347: Fasting and Procedural Sedation

Podcast # 347: Fasting and Procedural Sedation

Author: Sam Killian, MD Educational Pearls: Recent study examining fasting and adverse events during procedural sedation found no association between fasting duration and any type of adverse event....

29 Jun 20183min

Podcast # 346: Pediatric DKA

Podcast # 346: Pediatric DKA

Author: Chris Holmes, MD Educational Pearls: There is a risk of cerebral edema in pediatrics with DKA if over resuscitated. Recent study comparing normal saline vs. ½ normal saline showed no diff...

27 Jun 20184min

Podcast # 345: Epidural Abscess

Podcast # 345: Epidural Abscess

Author: Sue Chilton, MD Educational Pearls: IV drug use and spinal procedures are major risk factors. Classic triad of back pain, focal neurological deficit and fever. However, presence of fever ...

25 Jun 20184min

Podcast # 344: Foley troubleshooting

Podcast # 344: Foley troubleshooting

Author: Aaron Lessen, MD. Educational Pearls: When foley is stuck, balloon may not have deflated. Make sure balloon is not in the urethra, which can block drainage. Cut off the port as it may b...

22 Jun 20183min

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