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Emergency Medicine Cases

Best Case Ever 44 Low Risk Pulmonary Embolism

Emergency Medicine Cases

Dr. Anton Helman

Science, Courses, Medicine, Health & Fitness, Education

4.7602 Ratings

🗓️ 23 February 2016

⏱️ 21 minutes

🧾️ Download transcript

Summary

Dr. Salim Rezaie of R.E.B.E.L. EM tells his Best Case Ever of a Low Risk Pulmonary Embolism that begs us to consider a work-up and management plan that we might not otherwise consider. With new guidelines suggesting that subsegmental pulmonary embolism need not be treated with anticoagulants, exceptions to Well's Score and PERC rule to help guide work-ups, the adaptation of outpatient management of pulmonary embolism, and the option of NOACs for treatment, the management of pulmonary embolism in 2016 has evolved considerably. In which situations would you treat subsegmental pulmonary embolism? How comfortable are you sending patients home with pulmonary embolism? How does the patient's values play into these decisions? Listen to Dr. Rezaie provide an insightlful perspective on these important issues and much more...

Transcript

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0:00.0

Best case ever.

0:01.8

Best case ever.

0:09.8

Yes, this is E.N.K.'s best case ever mini podcast series, and I'm your host, Dr. Anton Helman. We're at the teaching course here in New York City.

0:31.4

And it's my pleasure and honor to have Dr. Salim Razai, the brains behind Rebel EM, the podcast and the blog.

0:42.0

And now I can proudly say one of my good buddies and co-foam producers.

0:48.4

Saleem, welcome to EM cases.

0:51.4

Anton, thank you for having me on.

0:52.7

This is long overdue.

0:55.7

And that's one of the beauties of foam, isn't it, that we really become good friends. It's not just producing good content, but we

1:01.4

know about each other, about our families and what's going on in our lives. And you're absolutely

1:06.2

right when you say, it can proudly say. And it's been a pleasure to meet you awesome so we're here to medicate so

1:13.8

selim let's hear your best case ever yeah so i was working a shift and had a patient come down to the

1:22.5

er 38 year old male so he really didn't have any medical problems and was kind of going about his ordinary

1:29.0

business and had been doing well. Actually, had gone to the gym and exercise, doing fine, just his

1:35.4

normal everyday routine. And all of a sudden, he was walking down some stairs and got this sudden

1:41.8

onset chest pain. And he described the pain as sharp like a knife

1:47.0

stabbed him in the right side of his chest. He said he suddenly couldn't breathe, he couldn't catch

1:52.7

his breath. He just felt fatigued, diaphragmatic, just didn't feel right. Actually took him about

1:59.7

30 minutes to make it down the rest of the flight of stairs

2:03.4

to make it somewhere where he could safely get to the emergency department.

2:08.3

What were you thinking at that time about what the diagnosis was?

2:11.9

Well, with the long travel, flights to the United States, probably about a 13-hour flight, stagnant. He said he

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