A Cook County Hospital Emergency Medicine Blog for up-to-date medicine and more.
We frequently discuss and teach the diagnostic algorithm for the evaluation of pulmonary embolism (PE). Beyond that, many learners will treat patients as either sick or not sick. In reality, the nuances of the middle ground can be the differences between life and death. Here, we discuss the evaluation and management of PEs in the ED.
Josué Rodriguez, MS4
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Figure 1. Adapted from Dr. Smith's EKG Blog. Source: http://hqmeded-ecg.blogspot.com/2013/10/polymorphic-ventricular-tachycardia.html
The Case:
A 40-year-old female presents to the emergency department for palpitations and lightheadedness. She has a history of depression on citalopram, migraines on amitriptyline, and was recently prescribed tramadol after she broke her wrist. She is well-appearing, and while being placed on the monitor, she becomes anxious, stating the symptoms are recurring. An ECG is performed, with Figure 1 serving as a representative EKG. The patient is awake and talking. Defibrillator pads are placed and 2 g IV magnesium is administered twice each over ten minutes resulting in the termination of the prior rhythm. A repeat EKG is obtained and is similar to that in Figure 2. The patient remains stable, but then degenerates again into an aberrant rhythm. What do you do next?
Adam Roussas, MD and Robert Feldman, MD
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Figure 1. Still image of B-lines on pulmonary POCUS.
The Case:
A 55-year-old female with a past medical history of hypertension, end-stage renal disease (ESRD) on hemodialysis, insomnia, depression, and opioid use disorder presents with rapidly worsening dyspnea that began several hours prior to arrival. She endorses an associated cough productive of clear sputum and admits to inhalation opioid use the day prior. She most recently received hemodialysis two days earlier and has not missed any sessions recently.
Michael Dorritie, DO
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