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Pulmonary embolism response team

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https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#1
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28571513/a-pulmonary-embolism-response-team-initial-experiences-and-future-directions
#2
Emily K Zern, Michael N Young, Kenneth Rosenfield, Christopher Kabrhel
Acute pulmonary embolism (PE) is a common cardiovascular condition resulting in significant morbidity and mortality. Consensus recommendations suggest risk stratification of patients into three main categories: high-risk or 'massive' PE, intermediate-risk or 'submassive' PE, and low-risk PE. Given the relative dearth of prospective, randomized clinical trials delineating optimal selection of the diverse medical, interventional, and surgical treatment approaches, clinical care requires a multidisciplinary expert approach to patients with PE...
June 2017: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/28557895/venous-thromboembolism-and-pulmonary-embolism-response-teams-an-overview
#3
Adebayo Fasanya, Kanan Silvas, Sulaiman Alhassan, Kaushal Patel, Anil C Singh, Khalid Malik
Venous thromboembolism is a common disease with a wide array of signs and symptoms. It has been cited as the third leading cause of cardiovascular death, and if left untreated, it leads to death in 1 in 4 patients. Sophisticated diagnostic tools have allowed physician to become more accurate in diagnosing pulmonary embolism and deep vein thrombosis. The advent of new oral anticoagulants, the emergence of pulmonary embolism response teams, and protocols demonstrate recent achievements in the management of venous thromboembolism...
July 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/28419620/comparison-of-emergency-department-patients-to-inpatients-receiving-a-pulmonary-embolism-response-team-pert-activation
#4
Erin K Deadmon, Nicholas J Giordano, Kenneth Rosenfield, Rachel Rosovsky, Blair Alden Parry, Rasha Fahad Al-Bawardy, Yuchiao Chang, Christopher Kabrhel
OBJECTIVES: The development of pulmonary embolism response teams (PERTs) has been widely adopted nationally with the goal of providing multidisciplinary care to patients with high-risk PE. Most PERT activations originate from the emergency department (ED), while others are from the intensive care unit (ICU) or inpatient floors. It is unclear if ED PERT activations differ from non-ED PERT activation in terms of presentation, management, and outcome. METHODS: We enrolled a consecutive cohort of patients for whom PERT was activated at an urban academic medical center...
April 17, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28401327/pulmonary-embolism-response-teams
#5
REVIEW
Maya Serhal, Ihab S Haddadin, Gustavo A Heresi, Deborah A Hornacek, Mehdi H Shishehbor, John R Bartholomew
Pulmonary embolism (PE) is a common thrombotic event that is variable in its presentation. Depending on the patients' risk for mortality, guidelines provide several treatment strategies including thrombolysis, catheter-directed therapies, pulmonary embolectomy, anticoagulation, and inferior vena cava filters. However, there is considerable disagreement between guidelines regarding the optimal treatment strategy for patients, particularly for those with intermediate-risk PE. In order to provide rapid and individualized care, PE response teams (PERT) have been developed...
April 11, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28325091/nuts-and-bolts-of-running-a-pulmonary-embolism-response-team-results-from-an-organizational-survey-of-the-national-pert%C3%A2-consortium-members
#6
Geoffrey Barnes, Jay Giri, D Mark Courtney, Soophia Naydenov, Todd Wood, Rachel Rosovsky, Kenneth Rosenfield, Christopher Kabrhel
OBJECTIVES: Pulmonary embolism response teams (PERT) are developing rapidly to operationalize multi-disciplinary care for acute pulmonary embolism patients. Our objective is to describe the core components of PERT necessary for newly developing programs. METHODS: An online organizational survey of active National PERT™ Consortium members was performed between April and June 2016. Analysis, including descriptive statistics and Kruskal-Wallis tests, was performed on centers self-reporting a fully operational PERT program...
March 31, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28265126/achieving-multidisciplinary-collaboration-for-the-creation-of-a-pulmonary-embolism-response-team-creating-a-team-of-rivals
#7
REVIEW
Christopher Kabrhel
Pulmonary embolism response teams (PERTs) have recently been developed to streamline care for patients with life-threatening pulmonary embolism (PE). PERTs are unique among rapid response teams, in that they bring together a multidisciplinary team of specialists to care for a single disease for which there are novel treatments but few comparative data to guide treatment. The PERT model describes a process that includes activation of the team; real-time, multidisciplinary consultation; communication of treatment recommendations; mobilization of resources; and collection of research data...
March 2017: Seminars in Interventional Radiology
https://www.readbyqxmd.com/read/28213377/interventional-treatment-of-pulmonary-embolism
#8
David M Dudzinski, Jay Giri, Kenneth Rosenfield
Pulmonary embolism (PE) is a serious and prevalent cause of vascular disease. Nevertheless, optimal treatment for many phenotypes of PE remains uncertain. Treating PE requires appropriate risk stratification as a first step. For the highest-risk PE, presenting as shock or arrest, emergent systemic thrombolysis or embolectomy is reasonable, while for low-risk PE, anticoagulation alone is often chosen. Normotensive patients with PE but with indicia of right heart dysfunction (by biomarkers or imaging) constitute an intermediate-risk group for whom there is controversy on therapeutic strategy...
February 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28208198/the-pulmonary-embolism-response-team-what-is-the-ideal-model
#9
Josanna Rodriguez-Lopez, Richard Channick
Treatment of patients with intermediate- and high-risk pulmonary embolism (PE) is a controversial area. Many therapeutic options exist, and deciding on appropriate treatment can be difficult. In addition, multiple specialties are often involved in the care of PE patients. To better organize the response to serious PE patients, several hospitals and academic centers across the United States, spearheaded by Massachusetts General Hospital, have created pulmonary embolism response teams (PERTs). The goal of a PERT is to have a single multidisciplinary team of experts in thromboembolic disease, who can respond rapidly to patients with acute PE, and offer consultation with the full spectrum of therapeutic options...
February 2017: Seminars in Respiratory and Critical Care Medicine
https://www.readbyqxmd.com/read/28123986/multidisciplinary-pulmonary-embolism-response-teams-and-systems
#10
Peter P Monteleone, Kenneth Rosenfield, Rachel P Rosovsky
Pulmonary embolism (PE) is a complex diagnosis that encompasses a wide range of clinical presentations. Often patients who present with PE have complicated medical histories which can make their management challenging. Many novel therapeutic strategies and tools are emerging to improve the care and outcomes of patients with PE. Pulmonary embolism response teams (PERTs) are developing at multiple centers to improve the decision making, efficiency and orchestration of these clinical strategies. Concordantly with development of PERT programs is the design and implementation of systems to allow for numerous specialists to convene and discuss complex PE patients in real time...
December 2016: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/27769084/pulmonary-embolism-response-teams
#11
REVIEW
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...
November 2016: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/27752629/pulmonary-embolism-the-diagnosis-risk-stratification-treatment-and-disposition-of-emergency-department-patients
#12
REVIEW
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: Clinical and Experimental Emergency Medicine
https://www.readbyqxmd.com/read/27567494/start-up-organization-and-performance-of-a-multidisciplinary-pulmonary-embolism-response-team-for-the-diagnosis-and-treatment-of-acute-pulmonary-embolism
#13
EDITORIAL
David M Dudzinski, James M Horowitz
No abstract text is available yet for this article.
January 2017: Revista Española de Cardiología
https://www.readbyqxmd.com/read/27552239/a-rare-case-of-hydromorphone-induced-angioedema-effectively-managed-by-a-difficult-airway-response-team
#14
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...
November 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27525184/screening-for-referral-by-a-sports-physical-therapist-reveals-an-effort-thrombosis-in-a-collegiate-pitcher-a-case-report
#15
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
https://www.readbyqxmd.com/read/27006156/a-multidisciplinary-pulmonary-embolism-response-team-initial-30-month-experience-with-a-novel-approach-to-delivery-of-care-to-patients-with-submassive-and-massive-pulmonary-embolism
#16
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
https://www.readbyqxmd.com/read/26916490/acute-pulmonary-embolism-with-an-emphasis-on-an-interventional-approach
#17
REVIEW
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
https://www.readbyqxmd.com/read/26214811/acute-pulmonary-embolism-network-and-multidisciplinary-response-team-approach-to-treatment
#18
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
https://www.readbyqxmd.com/read/25947348/pulmonary-embolism-response-teams
#19
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
https://www.readbyqxmd.com/read/25437222/computed-tomography-pulmonary-angiogram-as-a-result-of-medical-emergency-team-calls-a-5-year-retrospective-audit
#20
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
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