EM Quick Hits 23 – Clinical Probability Adjusted D-dimer, ARDS Part 2, Pharyngitis Mimics, Barotrauma, Vertigo, CPR Gender-Based Differences

Topics in this EM Quick Hits podcast Salim Rezaie on clinical probability adjusted D-dimer for pulmonary embolism (1:21) Bourke Tillmann on ARDS for the ED Part 2 - the vented ARDS patient in the ED (7:26) Brit Long & Michael Gottlieb on pharyngitis mimics (15:29) Justin Hensley on the many faces of barotrauma (24:04) Hans Rosenberg & Peter Johns on assessment of continuous vertigo - HINTS vs MRI (32:41) Justin Morgenstern & Jeannette Wolfe on gender-based differences in CPR (37:36) Podcast production, editing and sound design by Anton Helman. Voice editing by Raymond Cho and Sheza Qayyum Podcast content by Salim Rezaie, Bourke Tillmann, Brit Long, Michael Gottlieb, Justin Hensley, Hans Rosenberg, Peter Johns, Justin Morgenstern, Jeannette Wolfe and Anton Helman Written summary & blog post by Graham Mazereeuw, edited by Anton Helman Cite this podcast as: Helman, A. Rezaie, S. Tillman, B. M. Long, B. Gottlieb, M. Hensley, J. Rosenberg, H. Johns, P. Morgenstern, J. Wolfe, J. EM Quick Hits 23 - Clinical Probability Adjusted D-dimer, ARDS Part 2, Pharyngitis Mimics, Barotrauma, Vertigo, CPR Gender-Based Differences. Emergency Medicine Cases. October, 2020. https://emergencymedicinecases.com/em-quick-hits-october-2020/. Accessed [date]. Clinical Probability Adjusted D-Dimer: The PEGeD Study PEGeD Study - prospective study of 2,017 patients presenting to the ED with symptoms of pulmonary embolism (NEJM, 2019) * Approach: * 7-item Wells clinical prediction rule used to delineate low (0-4), moderate (4.5-6) or high (>6.5) risk of pulmonary embolism * Low risk group (n=1,752): discharged without CTPA if d-dimer below 1,000 ng/ml FEU * Moderate risk group (n=218): discharged without CTPA if d-dimer below 500 ng/ml FEU * High risk group (n=47): sent directly for CTPA * Zero patients discharged without CTPA based on adjusted d-dimer cutoffs had a pulmonary embolism at 3 months * 17.6% reduction in CTPA use with adjusted d-dimer cutoffs compared to a universal cutoff of 500 ng/ml FEU Bottom line: consider using clinical probability adjusted d-dimer cut offs if your ED has a typically low risk population Expand to view reference list * Kearon C, de Wit K, Parpia S, et al. Diagnosis of pulmonary embolism with d-dimer adjusted to clinical probability. N Engl J Med. 2019;381(22):2125-2134. * Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. * Anand Swaminathan, "PEGeD Study – Is It Safe to Adjust the D-Dimer Threshold for Clinical Probability?", REBEL EM blog, December 16, 2019. Available at: https://rebelem.com/peged-study-is-it-safe-to-adjust-the-d-dimer-threshold-for-clinical-probability/. ED Management of ARDS Part 2: The Vented ARDS Patient in the ED