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Emergency Medicine Cases

Episode 21: Pulmonary Embolism

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7602 Ratings

🗓️ 14 March 2012

⏱️ 84 minutes

🧾️ Download transcript

Summary

In this episode on Pulmonary Embolsim we have the triumphant return of Dr. Anil Chopra, the Head of the Divisions of Emergency Medicine at University of Toronto, and Dr. John Foote the CCFP(EM) residency program director at the University of Toronto. We kick it off with Dr. Foote's approach to undifferentiated dyspnea and explanation of Medically Unexplained Dyspea ('MUD') and go on to discuss how best to develop a clinical pre-test probability for the diagnosis of pulmonary embolism using risk factors, the value of the PERC rule, Well's criteria and how clinical gestalt plays into pre-test probability. Dr. Chopra tells about the appropriate use of D-dimer to improve our diagnostic accuracy without leading to over-investigation and unwarranted anticoagulation. We then discuss the value of V/Q scan in the workup of PE, and the pitfalls of CT angiography. A discussion of anticoagulation choices follows and the controversies around thrombolysis for submassive PE are reviewed.

Transcript

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0:00.0

Welcome to Emergency Medicine Cases.com. I'm your host, Dr. Anton Hellman, bringing you Canada's

0:08.1

brightest minds in emergency medicine from EMC Studios in Toronto. In this episode number 21, our first

0:17.9

installment on respiratory emergencies we have with us Dr. Anil Chopra and Dr. John

0:22.5

Foote. Dr. Anil Chopra is an emergency physician at the University Health Network in Toronto

0:27.6

and an associate professor in the Department of Medicine University of Toronto. He's the head

0:32.4

and medical director of emergency medicine services at the UHN hospitals. Dr. John Foote is an emergency physician

0:39.1

at Mount Sinai Hospital in Toronto and an assistant professor at the University of Toronto.

0:43.8

He's the program director for the CCFP-EM Emergency Medicine Fellowship Program at the University of

0:49.6

Toronto. P.O. C-O-P-D-P-E. These are diagnoses we contemplate, work up, and treat every week in the ED. While the basics

1:00.1

in managing these diseases are relatively straightforward, there's nuances to learn that can improve

1:05.1

our diagnostic accuracy, minimize the effects of needless imaging and treatment, improve

1:09.9

outcomes, and make us feel better

1:11.7

about the jobs we do in the emergency department. Often there's a lot of overlap in the clinical

1:16.1

presentation of these diagnoses, and it's sometimes tough to sort them out. Then there's the workup.

1:22.6

There's still disagreement about when to work up patients with PE and how best to work them up,

1:27.2

for example. There's even controversy as to which patients with PE and how best to work them up, for example.

1:28.4

There's even controversy as to which patients with PE should be thromboized.

1:32.7

And then there's the particularly tricky patients who present with shortness of breath,

1:36.7

like pregnant patients, for example.

1:39.3

Today, back by popular demand, we have with us the triumphant return of Dr. Anil Chopra and with him,

1:46.5

the blinding brilliance of Dr. John Foote, our CCFPEM Residency Program Director at U of

1:52.1

U of T.

...

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