Articles Tagged With:
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Overview and Instructions
Read each of the following sections. CME Questions are presented inline with links to begin the CME Post-Test. -
Pulmonary Embolism
For emergency physicians, acute pulmonary embolism (PE) provides a particularly complex diagnostic challenge. It has been estimated that 650,000 to 900,000 individuals annually suffer a fatal or nonfatal acute pulmonary embolism.1 While the classic textbook clinical presentation is well known, it is insufficiently accurate and precise in the timely diagnosis of an acute PE. In addition, many patients presenting with seemingly typical exacerbations of their underlying cardiopulmonary disease or other chronic illness may be masking symptoms of an undiagnosed acute pulmonary embolism.2 The high acuity coupled with the unreliable clinical presentation led to the development of several clinical tools, laboratory diagnostics, and radiographical studies to increase the clinician’s diagnostic power. This article we will review the Geneva Score and Wells Criteria, as well as the Kline and PERC rules. In addition, it will discuss special patient populations and diagnostic modalities for treating pulmonary emboli.
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Fewer Deaths, Lower Costs by Reducing Hospital-acquired Conditions
An estimated 50,000 fewer patients died in hospitals and about $12 billion in healthcare costs was saved by reducing hospital-acquired conditions.
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HHS to Emphasize Quality, Not Quantity
Is Medicare’s latest push about physician pay just another pie-in-the-sky initiative?
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When What Looks Like Strep Is Something Else
Lemierre's syndrome is making a comeback in adolescents and young adults.
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Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
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Intravenous Fluids in Patients With Acute Heart Failure
MONOGRAPH: Volume overload is a hallmark of acute heart failure. In hospitalized patients, intravenous loop diuretics are the most common treatment for decongestion.
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Only 1 HCW confirmed as occupationally infected with HIV in last 15 years, with 12 ‘possible’ cases
In the 1990s, tragic cases of healthcare workers who acquired AIDS and hepatitis on the job helped propel the movement for sharps safety. The evidence now shows the success of safer devices, standard precautions and post-exposure prophylaxis: In the past 15 years, only one health care worker developed HIV in a confirmed occupational exposure, according to a report from the Centers for Disease Control and Prevention.1
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Nurses report bullying, disrespectful behavior by other nurses similar to ‘hazing’
A common perception is that a lot of the bullying and disrespect that can create a toxic work culture in healthcare settings is directed by physicians toward nurses. Surprisingly, nurses appear to observe a hierarchy within their own ranks that may be just as mean-spirited, says Elaine Larson, PhD, RN, FAAN, CIC, associate dean for research at the Columbia School of Nursing in New York.
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Use screening tools, partnerships to improve identification, care of victims of IPV
With all the problems that emergency providers face on a daily basis, it can be especially difficult to identify and manage patients who may be victims of intimate partner violence (IPV). Some of these individuals are reluctant to share that they are in danger at home, and providers are often hesitant to push for this information — either because they lack ready access to resources to respond, or they aren’t sure what the next steps should be.