Moderator EMEDPA Posted September 1, 2013 Moderator Share Posted September 1, 2013 http://www.ncbi.nlm.nih.gov/pubmed/18812453 1 in 4 "acute exacebations of COPD" may actually be PE Link to comment Share on other sites More sharing options...
fireguy Posted September 1, 2013 Share Posted September 1, 2013 boy... thats a lot of CTAs. i guess you could do a d-dimer on everyone... boy thats even more CTAs... Link to comment Share on other sites More sharing options...
rcdavis Posted September 2, 2013 Share Posted September 2, 2013 I read the report. Unfortunately A low number of actual cases, but, essentially they are stating the In COPD exacerbations requiring Admission, almost 25% have, as the precipitant cause of that exacerbation, PEs. This makes sense. We really only admit COPD exacerbations which do not turn around well with Beta agonists, imitropium, steroids, bpap, etc, and the cxr and w/u fail to include failure or flash edema, pneumonia, MI, dysrythmia, etc We have all seen these guys.. And I have often wondered "what's changed?" to take the patient so far over the edge... As most COPDers have multiple coagulopathy risk factors ( cig, obesity, sedentary lifestyle, etc), this study demonstrates something that we probably should have intuited... That these guys are suffering from a significant new v/q mismatch due to the PE.... As far as screening dimers go, in any patient with new and/or worsening dyspnea, hypoxia, tachycardia ( eg COPDers), ALL should probably be screened by DImer in addition to PERC and other decision trees to consider the presence or low likelihood of clot... Especially in anyone sick enough to be admitted. Arguably, even in absence of screening, these patients sought to be anticoagulated with lmwh or Xa inhibitors during their hospitalization. 25 % is a pretty significant number.... Although I do reconize that 25 percent of COPDer admissions are not keeling over due to those PEs...I still feel that where there is one, there may well appear another.. And THAT one might be medically significant. Just my thoughts. Anyone have any comments on last weeks JAMA article advocating adding low dose vasopressin and moderate dose methyl prednisone in out of hospital cardiac arrests, continuing the steroid for 7 days, and this regimen increasing the rate of walking out of hospital survival from 4 to 15 percent ( eg almost a 400 percent increase in survival??? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 2, 2013 Author Moderator Share Posted September 2, 2013 Didn't see that article but will check but I heard about one that found vasopresin drips effective for ACEI associated angioedema which is frequently resistant to other standard tx. Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted September 2, 2013 Moderator Share Posted September 2, 2013 Where did you see that, E, about the vasopressin gtt for angioedema? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted September 2, 2013 Author Moderator Share Posted September 2, 2013 This isn't the study I was thinking of but is about anaphylaxis from bee stings with hypotensin tx with vasopresin.. will keep looking for the other one as it's out there somewhere: http://www.ncbi.nlm.nih.gov/pubmed/15178897?dopt=Abstract another, also not it: http://www.ncbi.nlm.nih.gov/pubmed/14766695?dopt=Abstract Link to comment Share on other sites More sharing options...
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