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Showing posts from December, 2015

An Age-Adjusted D-dimer Threshold for Emergency Department Patients With Suspected Pulmonary Embolus: Accuracy and Clinical Implications.

Methodology Score: 3/5                  Usefulness Score: 3/5
Sharp AL, Vinson DR, Alamshaw F, Handler J, Gould MK. Ann Emerg Med. 2015 Aug 27. pii: S0196-0644(15)00616-2.
Abstract Link
Retrospective study of 31,094 patients investigated for PE, evaluating a traditional D-Dimer of < 500, less than 1000 and an age-adjusted cutoff (age x 10). The age adjusted D-Dimer was associated with a significantly decreased sensitivity (93 vs 98%) but an increased specificity (64% vs 54%) compared to the traditional cutoff. The group agreed that this study does not promote the use of Age-Adjusted D-Dimer, but contributes to a mounting body of literature in favour of its utilization. By: Dr. Shahbaz Syed (Presented September 2015)

Epi lesson:  Likelihood Ratios:
For diagnostic tests, LR+ increases the post-test probability of a diagnosis and LR- decreases the post-test probability. LR values generally have this impact:
a) large and conclusive (LR+ >10, LR- <0.1), b) moderate (LR+ 5 to10, LR- 0.1 to…

Alcohol: Beyond the "Breakfast Plan"

Guest post by Dr. Chris Fabian
Acute alcohol intoxication and alcoholism are two separate and unique entities that we see regularly in the emergency department. As ER physicians, our role for the acutely intoxicated patient should focus on ruling out life threatening disease and ensuring their safety for discharge. 
Alcoholism, however, does predispose patients to many acute and chronic complications, in particular; Wernicke’s encephalopathy, alcoholic ketoacidosis and alcohol withdrawal. Background·Legal Limit = 0.08% (80mg/dL); approximate conversion to IU may be calculated by dividing by 5 (mmol/L) ·Metabolism of alcohol: oZero order kinetics at low concentrations (via Alcohol Dehydrogenase) oFirst order kinetics at high concentrations (via MEOS) ·Average rate of elimination is 3-9mmol/hr Acute Intoxication·In terms of detoxification; charcoal binds alcohol, but due to rapid absorption, there is no role for acute decontamination. ·Consider alternative diagnoses, ie: alcohol induced hypoglyc…