The American College of Physicians “best practice advice” for suspected pulmonary embolism

Pulmonary Embolism

The recommendations, based on a literature review and the best available evidence, include:

  • Use validated prediction rules (e.g., Wells or Geneva tools) to estimate a patient’s pretest probability of acute PE.
  • For patients with a low pretest probability who also meet all Pulmonary Embolism Rule-Out Criteria (PERC), neither D-dimer testing nor imaging should be performed. The PERC comprise eight variables (see link below).
  • For patients with an intermediate pretest probability or those who do not meet all PERC, perform high-sensitivity D-dimer testing; imaging should not be done initially.
  • For those over age 50, use age-adjusted D-dimer thresholds (instead of the usual 500 ng/mL) to decide whether to proceed to imaging; patients with a low-age-adjusted level should not undergo imaging.
  • For patients with a high pretest probability of PE, forego D-dimer testing and go straight to computed tomographic pulmonary angiography. If CTPA is contraindicated or unavailable, ventilation-perfusion lung scanning may be used.

 

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When it’s time to call off the resuscitation…

When to call it off

 

CEASE: (look for)

  • Clinical features that predict survival; (evaluate the)
  • Effectiveness of resuscitation efforts;
  • Ask the other clinicians present;
  • Stop resuscitation efforts;
  • Explain what has happened to the family.

Increased Calcium Intake Doesn’t Reduce Fracture Risk in Older People

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Increased calcium intake, whether from dietary sources or supplements, is unlikely to have a substantive clinical effect on bone mineral density (BMD) or fracture risk, two analyses in the BMJ find.

Drug Expiration Dates — Do They Mean Anything?

…the drug expiration date doesn’t really indicate a point at which the medication is no longer effective or has become unsafe to use. Medical authorities state expired drugs are safe to take, even those that expired years ago.