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Pulmonary embolism response team

Alison S Witkin, Savanah Harshbarger, Christopher Kabrhel
Pulmonary embolism is a common and often life-threatening event. Treatment options include anticoagulation alone, catheter-directed therapies, and surgical thromboembolectomy. While guidelines exist, there is often controversy over which treatment is most appropriate, particularly for intermediate-risk patients. The traditional care model, in which the primary team is responsible for consulting the appropriate specialists, may be inadequate and inefficient for emergent situations, as ensuring coordination and communication between various consulting services can be a time consuming and confusing process...
October 21, 2016: Seminars in Thrombosis and Hemostasis
Daniel Corrigan, Christiana Prucnal, Christopher Kabrhel
The diagnosis or exclusion of pulmonary embolism (PE) remains challenging for emergency physicians. Symptoms can be vague or non-existent, and the clinical presentation shares features with many other common diagnoses. Diagnostic testing is complicated, as biomarkers, like the D-dimer, are frequently false positive, and imaging, like computed tomography pulmonary angiography, carries risks of radiation and contrast dye exposure. It is therefore incumbent on emergency physicians to be both vigilant and thoughtful about this diagnosis...
September 2016: Clin Exp Emerg Med
David M Dudzinski, James M Horowitz
No abstract text is available yet for this article.
August 24, 2016: Revista Española de Cardiología
Scott Masson, Matthew Villerot, Bhavinkumar Dalal
Hydromorphone, unlike other opioids associated with histamine release, has never been reported to cause angioedema. We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room...
August 22, 2016: A & A Case Reports
William R VanWye, Jase Pinerola, Karen Craig Ogle, Harvey W Wallmann
BACKGROUND AND PURPOSE: Screening for referral, regardless of setting, is the responsibility of all physical therapists. A serious condition that sports physical therapists may encounter is upper extremity (UE) deep venous thrombosis (DVT), which can result in the important and sometimes fatal complication of pulmonary embolism. CASE DESCRIPTION: A 22 year-old male right-hand dominant collegiate pitcher was referred for physical therapist evaluation and treatment secondary to acute right UE pain and swelling...
August 2016: International Journal of Sports Physical Therapy
Christopher Kabrhel, Rachel Rosovsky, Richard Channick, Michael R Jaff, Ido Weinberg, Thoralf Sundt, David M Dudzinski, Josanna Rodriguez-Lopez, Blair A Parry, Savanah Harshbarger, Yuchiao Chang, Kenneth Rosenfield
BACKGROUND: Integrating newly developed tests and treatments for severe pulmonary embolism (PE) into clinical care requires coordinated multispecialty collaboration. To meet this need, we developed a new paradigm: a multidisciplinary Pulmonary Embolism Response Team (PERT). In this report, we provide the first longitudinal analysis of patients treated by a PERT. METHODS: Our PERT includes specialists in cardiovascular medicine and surgery, emergency medicine, hematology, pulmonary/critical care, and radiology, and is organized as a rapid response team...
August 2016: Chest
Wissam A Jaber, Pete P Fong, Giora Weisz, Omar Lattouf, James Jenkins, Kenneth Rosenfield, Tanveer Rab, Stephen Ramee
Compared with recent advances in treatment of serious cardiovascular diseases, such as myocardial infarction and stroke, the treatment and outcome of acute pulmonary embolism (PE) have remained relatively unchanged over the last few decades. This has prompted several experts to call for the formation of multidisciplinary PE response teams with a more proactive approach to the treatment of PE. In the current document, we discuss the formation of such teams and describe the available treatment options beyond anticoagulation, with a focus on the interventional approach...
March 1, 2016: Journal of the American College of Cardiology
Tyler L Bloomer, Eric J Thomassee, Pete P Fong
BACKGROUND: The ideal treatment strategy for acute pulmonary embolism (PE) remains a subject of debate. Treatment strategies vary based on numerous factors including the clinical scenario, hemodynamic variables, PE location, and personnel who are trained in advanced PE management therapies. METHODS: Similar to an acute myocardial infarction network, we created a regional referral system called the Acute PE Network to facilitate the transport of patients with PE from referring facilities and improve access to advanced therapies...
September 2015: Critical Pathways in Cardiology
Nosheen Reza, David M Dudzinski
Pulmonary embolism (PE) is a complex and multidimensional pathophysiology, the diagnosis and management of which spans multiple disciplines. The high morbidity and associated mortality of "massive" and "submassive" acute PE may require prompt, definitive management; however, current consensus guidelines in this domain are not supported by high-level evidence. Randomized clinical trials comparing available pharmacologic and invasive treatment modalities-including anticoagulation, thrombolysis, and embolectomy-have not been conducted and continue to be challenging to conceptualize, design, and execute...
June 2015: Current Treatment Options in Cardiovascular Medicine
Manisa Ghani, Antony Tobin
OBJECTIVE: To determine the proportion of computed tomography pulmonary angiograms (CTPAs), performed after medical emergency team (MET) calls, that are positive for pulmonary embolism (PE), and whether there are useful clinical predictors of positive CTPA results. DESIGN: All patients from a tertiary referral hospital in Melbourne who had an MET response and an associated CTPA within 6 hours, from 2009 to 2013, were included. We reviewed medical records to assess indications for CTPA, including MET clinical triggers, time of day of the MET (implying the seniority of decision making), chest x-ray results and Wells scores as a clinical decision rule for PE...
December 2014: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Tim Provias, David M Dudzinski, Michael R Jaff, Kenneth Rosenfield, Richard Channick, Joshua Baker, Ido Weinberg, Cameron Donaldson, Rajeev Narayan, Andrew N Rassi, Christopher Kabrhel
New and innovative tools have emerged for the treatment of massive and submassive pulmonary embolism (PE). These novel treatments, when considered alongside existing therapy, such as anticoagulation, systemic intravenous thrombolysis, and open surgical pulmonary embolectomy, have the potential to improve patient outcomes. However, data comparing different treatment modalities are sparse, and guidelines provide only general advice for their use. Treatment decisions rest on clinician expertise and institutional resources...
February 2014: Hospital Practice (Minneapolis)
Christopher Kabrhel, Michael R Jaff, Richard N Channick, Joshua N Baker, Kenneth Rosenfield
No abstract text is available yet for this article.
November 2013: Chest
Steven Deitelzweig
Total hip arthroplasty is a frequently performed orthopedic surgical procedure, and the number of these surgeries is expected to increase significantly over the coming years. Patients undergoing joint arthroplasty are at a particularly high risk for developing venous thromboembolic events (eg, deep vein thrombosis and pulmonary embolism). Prevention of postoperative complications is an important responsibility not only for orthopedic surgeons, but also for other clinicians involved in patients' care. Effective thromboprophylaxis is crucial to reduce the risk of developing venous thromboembolism following total hip arthroplasty and is an important goal of therapy...
April 2012: Hospital Practice (Minneapolis)
Samuel A Tisherman
In the perioperative period, patients may suffer complications leading to serious adverse events. Patient deterioration needs to be rapidly identified, and a rapid response system must be initiated. Additional personnel may also be needed. Rescue therapies, beyond the routine resuscitative efforts, may be needed in some cases. The types of complications that may be faced include a difficult airway, refractory hypoxemia, pulmonary embolism, myocardial infarction, cardiac arrest with restoration of pulse but ongoing coma, and stroke...
April 2012: Surgical Clinics of North America
Lawrence A Lynn, J Paul Curry
BACKGROUND: Respiratory alarm monitoring and rapid response team alerts on hospital general floors are based on detection of simple numeric threshold breaches. Although some uncontrolled observation trials in select patient populations have been encouraging, randomized controlled trials suggest that this simplistic approach may not reduce the unexpected death rate in this complex environment. The purpose of this review is to examine the history and scientific basis for threshold alarms and to compare thresholds with the actual pathophysiologic patterns of evolving death which must be timely detected...
2011: Patient Safety in Surgery
Panagiotis Ferentinos, Emmanouil Rizos, Christos Christodoulou, Paraskevi Nikolaidou, Despoina Chatzilia, Stelios Loukides, Spyros Papiris, Lefteris Lykouras
INTRODUCTION: Depression is known to have a bidirectional relationship with cardiovascular disease. Severe major depression associated with psychomotor retardation and immobility can be a risk factor for pulmonary embolism; the reverse pathway has not been reported. CASE REPORT: We report a case of a 61-year-old man diagnosed with multiple pulmonary thromboembolism finally attributed to a right pulmonary artery intraluminal sarcoma. One month after the onset of presenting symptoms, the patient suddenly developed an episode of severe, melancholic depression, which remitted in six weeks under treatment with venlafaxine 225 mg/day...
September 2010: General Hospital Psychiatry
Matthias Zimmer, Rainer Wassmer, Leo Latasch, Dieter Oberndörfer, Volker Wilken, Hanns Ackermann, Raoul Breitkreutz
AIM: This study is a description of the rate of unsafe acts and communication events in simulations of Emergency Medical Service (EMS) mission-based scenarios as first response for risk management and patient safety. SUBJECTS AND METHODS: The study involved video-based observation of German paramedic teams (n=40) during simulated EMS missions. Teams were randomised to four types of scenarios: advanced life support (ALS), bronchial asthma (BA), pulmonary embolism (PE) and multiple trauma (MT)...
July 2010: Resuscitation
Kelly A Arashin
The goals of Rapid Response Teams are to provide interventional care upon recognizing a clinical change in a patient's condition and to prevent further progression of declining health. There are many clinical situations in which the critical care nurse or advanced practice nurse can apply the Synergy Model to patient care. Understanding how the Synergy Model can guide the Rapid Response Team interventions and practice by identifying and matching patient and nurse characteristics can possibly achieve improved patient outcomes...
May 2010: Dimensions of Critical Care Nursing: DCCN
Gunnar Folprecht, Thomas Gruenberger, Wolf O Bechstein, Hans-Rudolf Raab, Florian Lordick, Jörg T Hartmann, Hauke Lang, Andrea Frilling, Jan Stoehlmacher, Jürgen Weitz, Ralf Konopke, Christian Stroszczynski, Torsten Liersch, Detlev Ockert, Thomas Herrmann, Eray Goekkurt, Fabio Parisi, Claus-Henning Köhne
BACKGROUND: Neoadjuvant chemotherapy for unresectable colorectal liver metastases can downsize tumours for curative resection. We assessed the effectiveness of cetuximab combined with chemotherapy in this setting. METHODS: Between Dec 2, 2004, and March 27, 2008, 114 patients were enrolled from 17 centres in Germany and Austria; three patients receiving FOLFOX6 alone were excluded from the analysis. Patients with non-resectable liver metastases (technically non-resectable or > or =5 metastases) were randomly assigned to receive cetuximab with either FOLFOX6 (oxaliplatin, fluorouracil, and folinic acid; group A) or FOLFIRI (irinotecan, fluorouracil, and folinic acid; group B)...
January 2010: Lancet Oncology
Renata Prado, Richard K Albert, Philip S Mehler, Eugene S Chu
Many in-hospital cardiac arrests and other adverse events are heralded by warning signs that are evident in the preceding 6 to 8 hours. By promptly intervening before further deterioration occurs, rapid response teams (RRTs) are designed to decrease unexpected intensive care unit (ICU) transfers, cardiac arrests, and inpatient mortality. While implementing RRTs is 1 of the 6 initiatives recommended by the Institute for Healthcare Improvement, data supporting their effectiveness is equivocal. Before implementing an RRT in our institution, we reviewed cases of failure to rescue and found that (1) poor outcomes were often associated with attempts to manage early decompensations without a bedside evaluation, and (2) the common causes of decompensation for floor patients (early sepsis, aspiration, pulmonary embolism) were within the scope of our primary teams' practice...
April 2009: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
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