UMEM Educational Pearls - By Rob Rogers

Title: Thrombolytic Therapy for Pulmonary Embolism

Category: Vascular

Keywords: Pulmonary Embolism, Thrombolytic (PubMed Search)

Posted: 7/23/2007 by Rob Rogers, MD (Updated: 11/22/2024)
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The only FDA-approved thrombolytic drug for the treatment of pulmonary embolism is tPA. Current studies (including studies by Jeff Kline-"Dr. PE") are investigating the use of TNKase and other agents. For hemodynamically unstable PE (hypotension, RV dysfunction): tPA- give 100 mg over two hours as a drip (no bolus). Heparin must be stopped during infusion and restarted after the tPA has finished. More on serum markers of RV dysfunction next week...

Title: Aortic Dissection

Category: Vascular

Keywords: aortic dissection, chest, abdominal, pain, malpractice (PubMed Search)

Posted: 7/16/2007 by Rob Rogers, MD (Updated: 11/22/2024)
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Most common themes in medical malpractice cases involving missed aortic dissection: -Some combination of chest/back, chest/abdomen, or abdomen/back -Symptoms "above and below" the diaphragm (neck pain and abdominal pain, for e.g.) Sullivan, SullivanGroup.com 2006 Acute Aortic Disease, Elefteriades 2007

Title: Pulmonary Embolism Rule Out

Category: Vascular

Keywords: D-Dimer, PE, Well's (PubMed Search)

Posted: 7/14/2007 by Rob Rogers, MD (Updated: 11/22/2024)
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Update on the Wells Criteria for PE-patients with a score of 4 or less (which means low to moderate probability) can be considered for a "d-dimer negative" rule out approach. This is a bit of a change from the low risk only approach. Additionally, the British Thoracic Society guidelines support the low and moderate risk group patient rule out strategy. So, if you have a low or even moderate risk patient, you can use the approach of obtaining a highly sensitive d-dimer and if it is negative, the hunt for PE is over.

Title: D-Dimer in Pregnancy

Category: Vascular

Keywords: D-Dimer, Pregnancy (PubMed Search)

Posted: 7/9/2008 by Rob Rogers, MD (Updated: 11/22/2024)
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D-Dimer levels are known to be elevated in pregnancy. But how high is too high and can this test be used in the workup of VTE in pregnant patients?

Recent literature indicates that D-dimer levels in each of the three trimesters are approximately 39% higher: 700, 1000, and 1400 ng/dL for each trimester (normal cutoff 500 ng/dL). So, figure out what trimester your patient is in and use the corresponding D-Dimer level for that trimester.