Welcome to another episode of the Journal Club with Dr Justin Morgenstern. This one is a bit epic and we start with a really important discussion around diagnostic strategies for palliative patients in the ED. There are a bunch of papers around PE and some interesting old school stuff that you likely would never consider unless you read it here! As always the articles are linked to free PDFs so you can make your own decisions.
Bottom line: This observational data suggests apixaban may be both more effective and safer than rivaroxaban, but there are so many limitations when trying to adjust retrospective data from a large database, confidence in this finding should be very low.
IVC induced D-dimer… a trial of 20 healthy volunteers 20 years ago…
Bottom line: This is a very small study using only healthy volunteers, so take it with a grain of salt. However, it probably makes sense to try to ensure your DDimer is taken on the first blood draw, rather than after the patient has had an IV in place for hours in the ED.
Bottom line: The risk of recurrent VTE in subsegmental PEs may not be negligible. As we gather more data on the topic, the best approach for emergency physicians is to ensure that you are only testing for PE in high risk patients.
Bottom line: I include this for interest’s sake only, as it sounds more like science fiction than medicine at this point (at least based on the funding of the emergency departments I work in), but it will be an interesting field to watch over the coming years.
Bottom line: Even in the worst infections, there is no reason to choose IV antibiotics over oral.
Can we say “Quiet” in the ED… yes. But this trial is silly
Geller JE, Strickland PO, Bucher JT. The use of the word “quiet” in the emergency department is not associated with patient volume: A randomized controlled trial. Am J Emerg Med. 2022 Mar 16;56:10-12. doi: 10.1016/j.ajem.2022.03.020. Epub ahead of print. PMID: 35339973
Bottom line: In the name of critical thinking education, I will continue to discuss how quiet my department is every single shift (and risk physical disability and lost friendships in the process)
DO NOT DELAY URGENT CONTRAST CTs WAITING FOR BLOOD WORK!!
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact