Great short video that gets to the point. It's always astounding to me - as you point out - all the variations in PE assessment that exist. I'm surprised that 2 decades past my training years, it's still not settled.
Very good video Dr. Strong, as usual :). Particularly usefull, if u take into consideration that european guidelines (Germany as ex ) go for 30 Pages at least (and that is the short version ) it's amazing how you can put almost everything you need in a < 20 min Video. Very well done :).
We rarely hear about it outside of a study because the d-dimer is used specifically to determine if a CTPA should be ordered. If the d-dimer is normal, we don't order a scan, so would never know if a patient had a PE.
Excellent sir.... Sir can I know the list of future videos you r planning.... And can we expect any updates on covid 19(the last video being 2 months old and many updates are floating now)
Thanks for the comment! My short list of future videos (i.e. those in the next couple of months) is constantly changing, but I anticipate posting several videos on pacemakers next week. Between now and the end of the summer, I'm also planning on videos covering the approach to back pain, a few more of the Strong Diagnosis series, and yes, one (or more) COVID updates.
Wouldn’t respiratory support help. It will resolve hypoxia mediated vasoconstriction and thus patient wont have phtn and thus no rv dysfunction and thus luv filling will improve.
I currently have a video on ischemic stroke, and ones on the approach to headache and vertigo. While I hope to add to this list someday, I do not anticipate any new neuro videos in the next few weeks (or even months). As a very rough rule, I try to time videos based on the academic calendar at my institution (including videos for new interns in the summer), and we cover neuro in Jan-Feb.
I'd say the most suggestive combination of findings in the history and exam would be acute cardiopulmonary symptoms (e.g. dyspnea, chest pain - particularly if unilateral and pleuritic, and/or syncope) + risk factor for thrombosis (e.g. recent surgery, active cancer) + exam findings of a DVT (e.g. unilateral red, warm, swollen leg). Classic vital sign abnormalities (e.g. tachycardia, tachypnea, hypoxemia) aren't that helpful since most other life-threatening causes of acute cardiopulmonary symptoms lead (e.g. ACS, arrhythmia, aortic dissection, pneumothorax, etc...) can lead to the same. Cardiac and pulmonary exams generally don't have any specific findings for PE; performing them is more to evaluate for alternative diagnoses.
Thanks for the comment! You are correct that it's a risk factor, and maybe I should have included it because of how common it is, but interestingly, the increased risk of VTE due to active smoking is surprisingly modest. For example, one study (pubmed.ncbi.nlm.nih.gov/27831499/) found an adjusted hazard ratio for provoked VTE of 1.36 (1.22-1.52), without conferring any increased risk of unprovoked PE. And review articles from Lancet (pubmed.ncbi.nlm.nih.gov/27375038/) and Medical Clinics of North America (pubmed.ncbi.nlm.nih.gov/30955521/) don't even mention it. Another consideration is that while smoking may convey mild risk, it conveys equal or greater risk of many other diseases that present with dyspnea and/or chest pain, so it's not as diagnostically helpful as the presence of other, more VTE-specific risk factors.
I'm sorry, but I can't provide specific, individualized medical advice on here. I recommend speaking with your own physician about any personal medical concerns.
I'm a rapid response nurse at a teaching hospital and your videos have been such a great resource. You're badass.
Wow. My department this week suddenly got an influx of cases of PE . And here Dr Eric comes and shed some light . Thanks Dr .
Great short video that gets to the point. It's always astounding to me - as you point out - all the variations in PE assessment that exist. I'm surprised that 2 decades past my training years, it's still not settled.
Thank u for your dedication and your videos Dr Strong! I am an ACNP student and your videos is helping me a lot! Stay strong and safe. 🙏❤️
Very good video Dr. Strong, as usual :).
Particularly usefull, if u take into consideration that european guidelines (Germany as ex ) go for 30 Pages at least (and that is the short version ) it's amazing how you can put almost everything you need in a < 20 min Video.
Very well done :).
Wow this was fantastic. I had forgotten so much. This was a great refresher.
Thank you for a great & thorough presentation.
Thank you Dr Strong . It is wonderful lecture and practical.
bless you for this content Dr. Strong. I know when I come to this channel I'll learn something new and get info I can trust
Thank you Dr Eric Strong! Could you please create a radiology series on Abdomen, It would be highly appreciated!
Thank you so much for doing this
Thank you for the video. Clearly explained
Your videos are helpful.
💖💖💖💖💖 helpful and well structurated
Nice topic sir specifically during these days of Covid 19, because we forget about rest of important medical issues.
Great presentation on a difficult topic
The lesson was very helpful. Thanks sir....
You are too good SIR🙌
I have never seen, read or heard about a “D-dimer-negative” PE case!
We rarely hear about it outside of a study because the d-dimer is used specifically to determine if a CTPA should be ordered. If the d-dimer is normal, we don't order a scan, so would never know if a patient had a PE.
Great
Thank you
Thankyou
Excellent sir.... Sir can I know the list of future videos you r planning.... And can we expect any updates on covid 19(the last video being 2 months old and many updates are floating now)
Thanks for the comment! My short list of future videos (i.e. those in the next couple of months) is constantly changing, but I anticipate posting several videos on pacemakers next week. Between now and the end of the summer, I'm also planning on videos covering the approach to back pain, a few more of the Strong Diagnosis series, and yes, one (or more) COVID updates.
This may seem like a stupid question...but after throbolectomy, why use heparin as upposed to a doac afterwards
Nice
Wouldn’t respiratory support help. It will resolve hypoxia mediated vasoconstriction and thus patient wont have phtn and thus no rv dysfunction and thus luv filling will improve.
Sir will there be more videos on concepts related to neurology??plz make some in coming days
I currently have a video on ischemic stroke, and ones on the approach to headache and vertigo. While I hope to add to this list someday, I do not anticipate any new neuro videos in the next few weeks (or even months). As a very rough rule, I try to time videos based on the academic calendar at my institution (including videos for new interns in the summer), and we cover neuro in Jan-Feb.
@@StrongMed ok sir
What are good indicators of a PE with exams available to paramedics or other pre-hospital personnel?
I'd say the most suggestive combination of findings in the history and exam would be acute cardiopulmonary symptoms (e.g. dyspnea, chest pain - particularly if unilateral and pleuritic, and/or syncope) + risk factor for thrombosis (e.g. recent surgery, active cancer) + exam findings of a DVT (e.g. unilateral red, warm, swollen leg). Classic vital sign abnormalities (e.g. tachycardia, tachypnea, hypoxemia) aren't that helpful since most other life-threatening causes of acute cardiopulmonary symptoms lead (e.g. ACS, arrhythmia, aortic dissection, pneumothorax, etc...) can lead to the same. Cardiac and pulmonary exams generally don't have any specific findings for PE; performing them is more to evaluate for alternative diagnoses.
@@StrongMed Thanks for the response doc!!
🌷💚
could you multiply yourself?
👍✳️👍✳️👍✳️
nice intro and outro
I think you missed out on smoking in the risk factors doc?
Thanks for the comment! You are correct that it's a risk factor, and maybe I should have included it because of how common it is, but interestingly, the increased risk of VTE due to active smoking is surprisingly modest. For example, one study (pubmed.ncbi.nlm.nih.gov/27831499/) found an adjusted hazard ratio for provoked VTE of 1.36 (1.22-1.52), without conferring any increased risk of unprovoked PE. And review articles from Lancet (pubmed.ncbi.nlm.nih.gov/27375038/) and Medical Clinics of North America (pubmed.ncbi.nlm.nih.gov/30955521/) don't even mention it. Another consideration is that while smoking may convey mild risk, it conveys equal or greater risk of many other diseases that present with dyspnea and/or chest pain, so it's not as diagnostically helpful as the presence of other, more VTE-specific risk factors.
Strong Medicine Thank you for the clarification!
Way to many words I can't pronounce or know what it is.😢
Sorry, this particular video is intended for medical trainees (i.e. medical/nursing students, interns, etc...).
The sound is too low.please use a mic
Sounds fine to me :/
Can I do sqauts and jogging with small pe
I'm sorry, but I can't provide specific, individualized medical advice on here. I recommend speaking with your own physician about any personal medical concerns.
While you are doing CTPA to a patient with score >6 , he will die
The Wells' score is a diagnostic tool, not a prognostic one.