Category: Pulmonary

The threshold for D-dimer remains an important topic in emergency medicine, critical care, and pulmonology. Emerging evidence, particularly from the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) introduced by Roy et al., suggests that we may need to adjust risk stratification and corresponding D-dimer thresholds. Recent data published in The Lancet Respiratory Medicine indicate that […]

The American Thoracic Society has recently published a Clinical Practice Guideline addressing key aspects of the diagnosis and management of community-acquired pneumonia (CAP). The guideline offers evidence-based recommendations on several clinically important questions, including the role of concurrent testing and treatment for viral infections in high-risk populations and the optimal duration of antibiotic therapy. Link […]

Choices of anticoagulation therapies are not simple as it was before, it does not mean that it was safer before. The new guideline from CHEST gave Level 2B recommendations to the new generation of NOVACs. Dabigatran (Grade 2B), Rivaroxaban (Grade 2B), Apixaban (Grade 2B), or Edoxaban (Grade 2B) was reviewed. Link to article  

British Thoracic Society/Intensive Care Society published a guideline regarding ventilatory management of acute hypercapnic respiratory failure(AHRF). I believe there are good recommendations for junior residents who do not know to deal with NIV machine and also setting initial parameter. This is augment our practice that how to approach COPD patient in ED with NIV. Link […]

Can we use Dexa instead of Prednisone when we are discharging patient home? old question and as I remember the answer was always Sure! but why are we asking still this question: Symptomatic improvement following emergency department management of asthma: a pilot study of intramuscular dexamethasone versus oral prednisone. J. Asthma 1997 2 articles within […]

We all shaky when we want to start Beta Blocker in COPD Patients! One of the traditional contraindication in COPD patients is using Beta Blcoker, Thorax BMJ reported a study that was done in US and showed betal blockers are  associated  with a significant reduction in COPD exacerbations regardless of severity of airflow obstruction.   […]

CHEST journal Published a systematic review and meta analysis regarding Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT. In this review, in patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis. Link […]

If we add nasal cannula to nonrebreather face mask or BVM with air leak, we will improve pre-oxygenation phase. This study that just published in Annals of EM enrolled 6o Healthy volunteers ,30 nonrebreather face mask and 30 bag-valve-mask. There will be an argument that Healthy lungs will be different from patients with restrictive or […]

Very happy to see US guided artery line is now in CHEST! Twelve trials used dynamic two-dimensional (2-D) ultrasound (N = 1,992). The study showed decreases first-attempt failure, mean attempts to success, mean time to success, and the occurrence of hematoma complications. Link to CHEST

We had a long journey to get here! I can’t tell how many times that I had argument with consultants regarding COPD or DKA patient that they ask for ABG and we had VBG! My old Post was focused mostly on DKA patient but Thanks to Throax that published a study among COPD patients. Using […]

Having a pregnant patient with suspected PE, you know what I’m talking about. It is usually a disaster, mom is worry about fetus, dad is worry about mom, you are worry about both! how much is the risk of PE in pregnancy?

Very nice mnemonic for Cavity lesion DDx in cxray: Cavity, C: Cancer or Mets, A: autoimmune; granulomas from, V: vascular (both bland and septic pulmonary embolus), I: infection(TB, fungall), T: trama (pneumatocoeles), Y: youth (congenital pulmonary airways malformation) Reference  

Dilemma:  cough, smoker, discoloured sputum,  diagnosis: Bronchitis, now: Abx or no Abx BMJ, Oct 2013: Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial

We are practicing short term of Steroid in management of asthma and COPD in ED, But this is very nice to hear from our colleagues to prove our practice. JAMA, in June 2013 published an article with concept of short term prednisone for 5 days is not inferior to