Podcasts about Pulmonary embolism

CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov.  The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.

What are the warning signs of a deep vein thrombosis (DVT) and pulmonary embolism (PE), and how is medical innovation changing how we treat blood clots today? In this episode of The Heart of Innovation, hosts Kim McNicholas and interventional cardiologist Dr. John Phillips sit down with Richard Davis, an engineer and medical developer whose life was completely rewritten after being hit by a truck at 23 years old. Richard shares his gripping story of survival—from being pinned inside a vehicle to developing life-threatening blood clots, surviving severe pulmonary embolisms, and ultimately transitioning his expertise into creating vascular medical devices that save lives. Discover how modern medical advancements are moving beyond standard medical therapy to actively remove clots and restore blood flow safely. TIMESTAMPS & CHAPTERS 0:00 - The Accident That Changed Everything 2:15 - Living with an Undiagnosed Clotting Disorder 4:40 - Facing a Life-Threatening Pulmonary Embolism 7:10 - Moving Beyond Medication: Advanced Clot Removal 9:35 - How Patient Participation Drives Medical Innovation 12:00 - The Next Generation of Vascular Care GET FREE MEDICAL SUPPORT & ACCESSIBLE RESOURCES If you or someone you know is dealing with deep vein thrombosis, severe leg pain, swelling, or vascular complications, find absolute support with our completely free community connections: Free Vascular Resources & Specialist Connections: https://www.padhelp.org Learn More About Enrolling in Clinical Trials: https://www.padtrials.org Call the Leg Saver Hotline: 1-833-PAD-LEGS (1-833-723-5347) Join the Private Facebook Support Group: http://www.PADsupportGroup.org Stream Live Radio Every Saturday Morning on AM 1220 KDOW or visit: https://www.theheartofinnovation.org                                          #PulmonaryEmbolism #VascularHealth #BloodClotSurvival #MedicalInnovation #TheHeartOfInnovation #PatientAdvocacy #DVTPrevention    

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

In this episode, Dr Swapnil Pawar is joined by Dr Jose Chacko to discuss the 2026 American Heart Association and American College of Cardiology guidelines on the management of pulmonary embolism. We cover the new A to E classification, evaluation and diagnostic algorithms, acute management including the role of PERT teams, advanced reperfusion therapies, and the updated recommendations on anticoagulation and follow-up. Welcome back after two years.

In this episode, hear Anthony Hunter, MD and Douglas Tremblay, MD discuss the various presentations of thrombotic events in patients with PV or ET including how thrombotic events may lead to diagnosis:  PV and ET increase the risk of both arterial and venous thrombotic events  Unusual thrombotic events  Thrombosis as initial presentation for MPN Case presentations Brief overview of thrombosis management Program faculty: Anthony M. Hunter, MD Associate Professor, Department of Hematology and Medical Oncology Leader, Myeloproliferative Neoplasm Program Medical Director, Rollins Immediate Care Center Winship Cancer Institute of Emory University, Leukemia Group Atlanta, Georgia Douglas Tremblay, MD Associate Professor of Medicine Division of Hematology/Oncology Tisch Cancer Institute Icahn School of Medicine at Mount Sinai New York, New York Link to obtain CME/CE credit: https://bit.ly/4egx4Rf Link to program page: https://bit.ly/3OPSASy Get access to all of our new podcasts by subscribing to the Decera Clinical Education Oncology Podcast on Apple Podcasts, YouTube Music, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

CardioNerds Drs. Dinu Balanescu, Billy-Joe Mullinax, and Mariana Garcia discuss systemic thrombolysis in pulmonary embolism with expert Dr. Allison Burnett. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Pulmonary embolism is the third leading cause of cardiovascular death in the US, and high-risk PE carries a 30-day mortality risk as high as 30-50%. In this episode, we discuss the indications for systemic thrombolysis, including high-risk PE and cardiac arrest. We addressed how to appropriately select candidates for systemic thrombolysis, balancing the high risk of bleeding. Additionally, we discussed anticoagulation management and timing concurrent with lytic therapy, as well as the importance of multidisciplinary PERT teams.  The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Risk stratification is crucial in acute pulmonary embolism care. Based on the ESC 2019 guidelines, low-risk PE patients are those who are normotensive with no evidence of right ventricular dysfunction. Intermediate risk includes two categories: intermediate-low, with normotensive patients who have a high PE score with negative biomarkers, and intermediate-high risk, which has elevated biomarkers or signs of RV strain. High-risk PE includes hemodynamically unstable patients (SBP

Contributor: Aaron Lessen, MD Educational Pearls: Patients with pulmonary embolism (PE) are divided into three risk categories Low risk (non-massive PE): patients are stable Treatment: prescribe anticoagulants and discharge home Intermediate risk (submassive PE): patients are stable but display evidence of clot burden such as elevated troponin, elevated BNP, and/or right heart strain Treatment is controversial High risk (massive PE): patients are unstable with hypotension, hypoxia, and/or respiratory distress Treatment: IV thrombolysis to prevent decompensation A recent randomized controlled trial evaluated treatment of intermediate risk PE patients Patients were randomized to receive either thrombectomy with anticoagulation or anticoagulation alone The primary outcome evaluated changes in right ventricular enlargement at 48 hours A controversial primary outcome because it does not speak to mortality or incidence of other necessary aggressive interventions Low clinical significance The study found that thrombectomy significantly reduced right ventricular enlargement faster than anticoagulation alone. However, there was no statistical difference in mortality or need for other treatments Treatment for intermediate risk PE patient remains controversial The same study will have second follow-up at 90 days to see if there are other benefits References Lookstein RA, Konstantinides SV, Weinberg I, Dohad SY, Rosol Z, Kopeć G, Moriarty JM, Parikh SA, Holden A, Channick RN, McDonald B, Nagarsheth KH, Yamada K, Rosovsky RP; STORM-PE Trial Investigators. Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial. Circulation. 2026 Jan 6;153(1):21-34. doi: 10.1161/CIRCULATIONAHA.125.077232. Epub 2025 Nov 3. PMID: 41183181. Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4 Donate: https://emergencymedicalminute.org/donate/

We are unbelievably excited this week to be reviewing the hot-off-the-presses 2026 Multi-Society (AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN) Pulmonary Embolism Guidelines with lead author Dr. Mark A. Creager. We will talk about key updates in these guidelines compared to prior practice, including the new risk classification model, and provide an overview from diagnosis to follow-up. Given the clinical importance and prevalence of pulmonary embolism, these guidelines are certainly going to shape practice going forward, so this episode is a can’t miss! Watch the full video of this episode with graphics and helpful teaching visuals on our YouTube channel: https://www.youtube.com/@pulmpeeps Meet Our Guest Dr. Mark Creager is a Professor of Medicine at Dartmouth Hitchcock Medical Center where he specializes in Cardiovascular Medicine with an emphasis on venous thromboembolic disease. He served as the lead author of the 2026 Pulmonary Embolism Guidelines. Article and Reference Creager MA, Barnes GD, Giri J, Mukherjee D, Jones WS, Burnett AE, Carman T, Casanegra AI, Castellucci LA, Clark SM, Cushman M, de Wit K, Eaves JM, Fang MC, Goldberg JB, Henkin S, Johnston-Cox H, Kadavath S, Kadian-Dodov D, Keeling WB, Klein AJP, Li J, McDaniel MC, Moores LK, Piazza G, Prenger KS, Pugliese SC, Ranade M, Rosovsky RP, Russo F, Secemsky EA, Sista AK, Tefera L, Weinberg I, Westafer LM, Young MN. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2026 Feb 19:S0735-1097(25)10161-7. doi: 10.1016/j.jacc.2025.11.005. Epub ahead of print. PMID: 41712898. Key Learning Points Why these guidelines matter: This is the first joint AHA/ACC clinical practice guideline specifically on acute PE, bringing together a truly multidisciplinary writing committee (cardiology, pulmonology, hematology, emergency medicine, interventional radiology, surgery, and others). Prior guidelines existed from individual societies, but nothing this comprehensive had been updated in roughly five to six years. New PE clinical categories (A through E): One of the most impactful changes is replacing the old “massive/submassive” and “low/intermediate/high risk” labels with five categories that form a severity continuum. Category A is subclinical (incidental PE found on imaging in asymptomatic patients). Category B covers symptomatic but low-severity patients. Category C is where much of the clinical complexity lives — symptomatic, hemodynamically stable patients subdivided into C1, C2, and C3 based on RV function and biomarkers. Category D represents incipient cardiopulmonary failure (transient hypotension, normotensive shock with end-organ dysfunction). Category E is frank cardiopulmonary failure, with E2 being the sickest — refractory or recurrent cardiac arrest. Respiratory modifiers (hypoxia requiring supplemental oxygen) layer onto C, D, and E. Diagnostic approach: Clinical evaluation comes first — history, exam, and validated decision tools (Wells score, revised Geneva, PERC). If clinical probability is low and D-dimer is normal, imaging can be safely avoided. If either is concerning, imaging is warranted. CTPA remains the preferred imaging modality due to superior sensitivity, specificity, wide availability, and ability to assess clot burden and alternative diagnoses. VQ scanning is still appropriate when CTPA is contraindicated, and VQ SPECT offers better reproducibility and specificity than traditional planar VQ if available. Echocardiography is not a diagnostic test for PE but is important for risk stratification — RV size, TAPSE, and tissue Doppler measures all contribute prognostic information. Anticoagulation updates: Anticoagulation remains the cornerstone of treatment. For patients potentially needing advanced therapies (C3, D, E), parenteral anticoagulation is started first. A notable recommendation: low molecular weight heparin is generally preferred over unfractionated heparin, based on evidence showing more effective VTE risk reduction, more predictable pharmacokinetics, no need for routine monitoring, lower rates of heparin-induced thrombocytopenia, and no increase in major bleeding. The committee acknowledged this may create discomfort for clinicians accustomed to unfractionated heparin’s easy reversibility, but the difficulty of achieving and maintaining therapeutic levels with UFH was a significant concern. Advanced therapies: Catheter-based thrombolysis, mechanical thrombectomy, systemic thrombolysis, and surgical embolectomy all received mostly class 2B recommendations (“can consider”) for C3 and D categories, reflecting that current evidence shows improvement in short-term surrogate measures (RV/LV ratio, hemodynamics) but lacks definitive hard outcome data on mortality. For category E1 patients, recommendations are stronger (class 2A). Multiple trials are expected soon — HI-PEITHO, PEERLESS-2, PE-TRACT, PERSEVERE, TORPEDO, and PROG — that should substantially inform future updates. PERT teams: Pulmonary embolism response teams are encouraged, particularly for C3, D, and E patients. They’ve been shown to reduce length of stay. For institutions without PERT capability, establishing consultation networks with larger centers is recommended. Post-PE follow-up: Patients shouldn’t be “left in the wilderness” after discharge. The guidelines recommend communication within the first week to ensure understanding of diagnosis and treatment, an in-person visit at or before three months to assess for persistent symptoms and discuss anticoagulation duration, ongoing surveillance for chronic thromboembolic pulmonary disease, and periodic reassessment for those on extended anticoagulation. Infographics

Ayesha Zia, MD, is a Professor of Pediatrics at UT Southwestern Medical Center and a nationally recognized expert in pediatric thrombosis, with particular emphasis on the diagnosis, management, and long-term outcomes of pulmonary embolism in children and adolescents. She serves as Director of the Pediatric Hemostasis and Thrombosis Program at Children's Health Dallas. She has led the development of a collaborative multidisciplinary approach to pediatric PE care, including pulmonary embolism response teams. Her October 2025 publication in Blood “How I treat pediatric pulmonary embolism” is the topic of today's discussionLearning Objective: By the end of this podcast, listeners should be able to describe an evidence-based and expert-guided approach to the diagnosis, risk stratification and management of pulmonary embolism in children.References:Zia A, Goldenberg NA, Rajpurkar M. How I treat pediatric pulmonary embolism. Blood. 2025 Oct 2;146(14):1643-1653. doi: 10.1182/blood.2024026599. Dang MP, Cheng A, Garcia J, Lee Y, Parikh M, McMichael ABV, Han BL, Pimpalwar S, Rinzler ES, Hoffman OL, Baltagi SA, Bowens C, Divekar AA, Davis Volk AP, Huang CJ, Veeram Reddy SR, Arar Y, Zia A. Bringing PERT to Pediatrics: Initial Experience and Outcomes of a Pediatric Multidisciplinary Pulmonary Embolism Response Team (PERT). Chest. 2025 Mar;167(3):851-862.Mercurio L, Corwin D, Kaplan R, Ellison AM, Casper TC, Kuppermann N, Kline JA. Bedside exclusion of pulmonary embolism in children without radiation (BEEPER): a national study of the Pediatric Emergency Care Applied Research Network-Study protocol. Res Pract Thromb Haemost. 2023 Jan 14;7(2):100046. Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

In this episode Dr. Sergio Zanotti discusses the recently released Clinical Practice Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. This guideline is a report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. He is joined by Dr. Mark Creager, the lead author and chair of the writing committee for these guidelines. Dr. Creager is Professor of Medicine and Professor of Surgery at the Geisel School of Medicine at Dartmouth. A past president of the American Heart Association, he is an internationally recognized leader in vascular and cardiovascular medicine with more than 400 scientific publications. Additional resources: 2026 AHA/ACC/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults: A Report of the American College of Cardiology / American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2026: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001415 Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2023: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001117 Antithrombotic Therapy for VTE Disease: Second Update of the CHEST Guideline and Expert Panel Report. CHEST 20: https://journal.chestnet.org/article/S0012-3692(21)01506-3/fulltext Books mentioned in this episode: Team of Rivals: The Political Genius of Abraham Lincoln. By Doris Kearns Goodwin: https://bit.ly/4skCS0c Alexander Hamilton. By Ron Chernow: https://bit.ly/4rFuxTw Vascular Medicine: A Companion to Braunwald's Heart Disease. By Mark Creager et al.: https://bit.ly/4uHZ4Dc

Beyond Sports is the ESPN public affairs show. Airing Sunday mornings, from 5-6am, Beyond Sports presents topical guests and stories in an entertaining and comfortable format. Each week your host, Hannah Stanley, brings a new show covering a current issue, news item, upcoming event, or local charity. About Hannah Hannah Stanley is the Public Affairs Manager for ESPN AM 1000. She is co-chair of the Chicago Chapter of the Disney VoluntEars, and involved with TEAM ESPN. She resides in the western suburbs with her husband and children. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj ⁠⁠Dr. Raj on Twitter⁠⁠ ⁠⁠Dr. Raj on Instagram⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

This inaugural episode of the CardioNerds Pulmonary Embolism (PE) Series explores the evolution of acute PE care. Dr. Ibrahim Zahid, Dr. Dinu Balanescu, and Dr. Billy Joe Mullinax join guest expert Dr. Kenneth Rosenfield to discuss the shifting landscape of PE management. Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality and a frequent diagnostic challenge, often masquerading as myocardial infarction or a benign illness. Over the past decade, PE care has evolved from anticoagulation-only strategies to nuanced, risk-stratified, multidisciplinary management. Modern approaches integrate hemodynamics, biomarkers, and advanced imaging to guide therapy, including catheter-directed interventions and large-bore thrombectomy. The Pulmonary Embolism Response Team (PERT) model addresses historical gaps by coordinating rapid, multispecialty decision-making and standardizing care pathways. The PERT Consortium further advances PE care through education, research, and the world's largest PE registry, while fostering leadership and research opportunities for trainees. Despite advances, long-term outcomes and post-PE syndromes remain important areas for future investigation. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls PE is a “master masquerader”—maintain suspicion for atypical presentations like myocardial infarction, heart failure, flu, or anxiety. Multidisciplinary management mediated through pulmonary embolism response teams improves outcomes and standardizes care. Risk stratification integrates hemodynamics, biomarkers, and imaging. Advanced therapies have expanded beyond anticoagulation. Long‑term follow‑up and post‑PE syndrome need more research. Notes Notes: Notes drafted by Dr. Ibrahim Zahid. 1. How has the clinical approach to PE changed over the past decade? PE is the third leading cause of cardiovascular death and historically under‑recognized. Symptoms mimic MI, HF, asthma, syncope, and more.PE is a silent killer, and it should be recognized more as a cause of spontaneous cardiac arrest. Where life threatening disease like stroke which is owned by neurological specialists and MI is primarily managed by cardiac specialists, PE is an entity without a professional home. The PERT Consortium brings the specialties together for PE care. 2. Ten years ago, a 58-year-old patient with a large bilateral PE, RV dilation, and positive biomarkers might have been managed with anticoagulation and close observation alone. Today, with evolving—but still uneven—data on advanced therapies, PE care feels far more nuanced and highly dependent on where you practice. What are the major gaps in traditional PE management that clinicians should recognize, and what care pathways should they be aware of across different hospital systems? Care has shifted from anticoagulation‑only to multidisciplinary approaches like catheter directed thrombectomy. Risk‑based pathways and the use of CT angiogram has improved early recognition. Risk stratification tools must be used as tools for early recognition of intermediate risk PE. Untreated PE leads to chronic complications like chronic thromboembolic disease and chronic thromboembolic pulmonary hypertension, which requires long term clinic follow up. 3. What is the role of risk stratification tools such as PeSI, sPeSI scores, cardiac biomarkers, and imaging findings in PE, and how do they guide treatment decisions in real world practice? Integrate vitals (blood pressure and heart rate), biomarkers (troponin, pro-BNP), RV/LV ratio assessment, acid‑base status, and scores. Tools include PESI, sPESI, BOVA, HESTIA, FAST, Geneva, NEWS, shock index. Vitals, lactate, acid-base status, and tools like NEWS or shock index track clinical evolution. PESI/sPESI estimate 30-day mortality and help identify low-risk patients who may be candidates for early discharge or outpatient therapy. Clinical judgment matters—scores don't fully capture clot burden, trajectory, or bleeding risk. 4. How was the pulmonary embolism response team created, and since its creation, what evidence or outcome data became available to support the PERT model? Originated after a sentinel case at MGH: A young, pregnant woman in her 30s, who collapsed at home, underwent thrombectomy, and had to be on ECMO for a few days. The case brought cardiology, cardiac surgeons and critical care physicians together for planning and improvement in her health, which was rewarding. Thereby, it was decided to bring specialties involved in PE care together to create a response team. The name of the team, Pulmonary Embolism Response Team (PERT), was coined by Richard Channick in the first meeting. Posters were set up all over the hospital to call a centralized line when an acute PE is recognized A meeting was held to present the concept of putting together a consortium, with development of action items and a PERT database. Enabled rapid multidisciplinary input using early teleconferencing tools. 5. Given concerns about having too many ‘cooks in the kitchen' during the initial PE call—especially with rotating teams—how can institutions reconcile workflow complexity with standardized pathways in a way that meaningfully supports and justifies the added burden on frontline clinicians? Every hospital's PERT is different, catering to their needs and workflow At least two disciplines are needed to make a PERTData is currently being collected to guide further on how the workflow can be standardized Most importantly, the team brings in resources that were not available prior to PERT formation. 6. What are the main goals of the PERT consortium, and how does it support clinicians and institutions involved? To improve care and improve outcomes for patients with PE Expand education, refine algorithms, standardize care with Centers of Excellence. Maintain the largest PE registry for research and outcomes improvement. 7. Beyond global networking, shared learning from successful systems, and the pathway toward Center of Excellence designation, what additional benefits can clinicians and health systems gain by participating in the PERT Consortium? The ability to learn from other systems, the ability to share experiences. Allow people to develop their professional careers like leadership experience, becoming a member of the trainee council Initiate projects and receive funding for your ideas 8. For trainees interested in pulmonary embolism care, how can a trainee be a champion at their institution? Does PERT provide assistance and how can they really contribute meaningfully even before becoming a fellow/attending? Medical students and residents interested in PE should reach out to the consortium and the consortium will hook you up with the correct mentors who can nurture you along. Listen to the podcasts. Participate with your local PERT team PERT wants involvement of people who are social media savvy to help spread the word on PE. Top three take-away points from this episode Acute PE care has advanced and multiple treatment modalities for acute PE including catheter directed therapy, large bore thrombectomy, are becoming standard of care. Multidisciplinary models like PERT improve coordination and outcomes. Trainees play a vital role in advancing PE care through involvement, research, and education References Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. doi: 10.1093/eurheartj/ehz405. PMID: 31504429. https://pubmed.ncbi.nlm.nih.gov/31504429/ Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019 Jun 9;3(3):315-330. doi: 10.1002/rth2.12216. PMID: 31294318; PMCID: PMC6611377. https://pmc.ncbi.nlm.nih.gov/articles/PMC6611377/ Rosenfield K, Bowers TR, Barnett CF, Davis GA, Giri J, Horowitz JM, Huisman MV, Hunt BJ, Keeling B, Kline JA, Klok FA, Konstantinides SV, Lanno MT, Lookstein R, Moriarty JM, Ní Áinle F, Reed JL, Rosovsky RP, Royce SM, Secemsky EA, Sharp ASP, Sista AK, Smith RE, Wells P, Yang J, Whatley EM; Pulmonary Embolism Research Collaborative (PERC) Attendees. Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report From the Pulmonary Embolism Research Collaborative. Circulation. 2024 Oct;150(14):1140-1150. doi: 10.1161/CIRCULATIONAHA.124.067482. Epub 2024 Sep 12. PMID: 39263752; PMCID: PMC11698503. https://pubmed.ncbi.nlm.nih.gov/39263752/ Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism. Vasc Med. 2019 Apr;24(2):103-109. doi: 10.1177/1358863X18824159. Epub 2019 Mar 5. PMID: 30834822. https://pubmed.ncbi.nlm.nih.gov/30834822/ Pandya V, Chandra AA, Scotti A, Assafin M, Schenone AL, Latib A, Slipczuk L, Khaliq A. Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature. J Clin Med. 2024 Jul 8;13(13):3984. doi: 10.3390/jcm13133984. PMID: 38999548; PMCID: PMC11242386. https://pubmed.ncbi.nlm.nih.gov/38999548/ Rivera-Lebron B., McDaniel M., Ahrar K., Alrifai A., Dudzinski D.M., Fanola C., Blais D., Janicke D., Melamed R., Mohrien K., et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin. Appl. Thromb. Hemost. 2019;25:1076029619853037. doi: 10.1177/1076029619853037.https://pubmed.ncbi.nlm.nih.gov/31185730/

New AHA/ACC guidelines overhaul pulmonary embolism management with a five-tier risk classification, endorsing ED discharge for low-risk patients and DOACs as first-line therapy. A JAMA trial confirms IV acetaminophen adds modest but real pain relief when combined with morphine. A large cohort study shows SGLT2 inhibitors dramatically reduce kidney, cardiovascular, and liver complications in diabetic cirrhosis patients.

In this episode, Dr. Austin Rupp and I try to answer the following questions:Should patients with provoked VTE be offered long term anticoagulation if they have persistent risk factors, like obesity? Does coffee make atrial fibrillation worse (or better??)? Is age-adjusted d-dimer safe to use in DVT? Should we prescribe beta blockers after acute MI if the EF is normal?Does fish oil improve cardiovascular outcomes in patients on dialysis?What's the best approach for dialysis in patients with acute kidney injury?The articles:Extended Apixaban for Provoked VTE (HI-PRO)Coffee and Atrial Fibrillation (DECAF)Age-Adjusted D-dimer for DVT (ADJUST-DVT)Beta-blockers after MI with normal EFFish Oil in Dialysis Patients (PISCES)Conservative Dialysis in AKI (LIBERATE-D)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

There are new details concerning the death of actor Catherine O'Hara. AP's Lisa Dwyer has the details.

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj ⁠⁠⁠⁠The Dr. Raj Podcast⁠⁠⁠⁠ ⁠⁠⁠⁠Dr. Raj on Twitter⁠⁠⁠⁠ ⁠⁠⁠⁠Dr. Raj on Instagram⁠⁠⁠⁠ Want more board review content? ⁠⁠⁠⁠USMLE Step 1 Ad-Free Bundle⁠⁠⁠⁠ ⁠⁠⁠⁠Crush Step 1⁠⁠⁠⁠ ⁠⁠⁠⁠Step 2 Secrets⁠⁠⁠⁠ ⁠⁠⁠⁠Beyond the Pearls⁠⁠⁠⁠ ⁠⁠⁠⁠The Dr. Raj Podcast⁠⁠⁠⁠ ⁠⁠⁠⁠Beyond the Pearls Premium⁠⁠⁠⁠ ⁠⁠⁠⁠USMLE Step 3 Review⁠⁠⁠⁠ ⁠⁠⁠⁠MedPrepTGo Step 1 Questions⁠⁠⁠⁠ ⁠⁠⁠⁠MedPrepTGo Step 2 Questions⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj ⁠⁠⁠The Dr. Raj Podcast⁠⁠⁠ ⁠⁠⁠Dr. Raj on Twitter⁠⁠⁠ ⁠⁠⁠Dr. Raj on Instagram⁠⁠⁠ Want more board review content? ⁠⁠⁠USMLE Step 1 Ad-Free Bundle⁠⁠⁠ ⁠⁠⁠Crush Step 1⁠⁠⁠ ⁠⁠⁠Step 2 Secrets⁠⁠⁠ ⁠⁠⁠Beyond the Pearls⁠⁠⁠ ⁠⁠⁠The Dr. Raj Podcast⁠⁠⁠ ⁠⁠⁠Beyond the Pearls Premium⁠⁠⁠ ⁠⁠⁠USMLE Step 3 Review⁠⁠⁠ ⁠⁠⁠MedPrepTGo Step 1 Questions⁠⁠⁠ ⁠⁠⁠MedPrepTGo Step 2 Questions⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj ⁠⁠The Dr. Raj Podcast⁠⁠ ⁠⁠Dr. Raj on Twitter⁠⁠ ⁠⁠Dr. Raj on Instagram⁠⁠ Want more board review content? ⁠⁠USMLE Step 1 Ad-Free Bundle⁠⁠ ⁠⁠Crush Step 1⁠⁠ ⁠⁠Step 2 Secrets⁠⁠ ⁠⁠Beyond the Pearls⁠⁠ ⁠⁠The Dr. Raj Podcast⁠⁠ ⁠⁠Beyond the Pearls Premium⁠⁠ ⁠⁠USMLE Step 3 Review⁠⁠ ⁠⁠MedPrepTGo Step 1 Questions⁠⁠ ⁠⁠MedPrepTGo Step 2 Questions⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj ⁠The Dr. Raj Podcast⁠ ⁠Dr. Raj on Twitter⁠ ⁠Dr. Raj on Instagram⁠ Want more board review content? ⁠USMLE Step 1 Ad-Free Bundle⁠ ⁠Crush Step 1⁠ ⁠Step 2 Secrets⁠ ⁠Beyond the Pearls⁠ ⁠The Dr. Raj Podcast⁠ ⁠Beyond the Pearls Premium⁠ ⁠USMLE Step 3 Review⁠ ⁠MedPrepTGo Step 1 Questions⁠ ⁠MedPrepTGo Step 2 Questions⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Rachel Rosovsky, MD, MPH, discusses the STORM-PE study, which showed the benefits of adding CAVT to anticoagulation for PE.

Pulmonary embolisms don't always announce themselves... sometimes they ambush. One minute your patient is walking with physical therapy, the next they're hypotensive, hypoxic, and coding. This re-released early episode dives deep into why PE patients can look deceptively stable… right up until they aren't.In this episode, I revisit one of my earliest case-based teachings on pulmonary embolism, updated with an added segment on vasopressin use in obstructive shock from PE. Through real bedside stories from my time as a rapid response and ER nurse, we break down the physiology behind PE-related collapse, why intubation isn't always the answer, and how to think through management when the right ventricle is failing in front of you. This is a sobering but essential refresher on one of the most dangerous diagnoses we encounter.Topics discussed in this episode:Why pulmonary embolism is a common cause of in-hospital cardiac arrest (even if it's not common overall)Classic and subtle PE presentations and why they're often missedA real-time rapid response case: stable to crashing in minutesRisk factors for PE and the anticoagulation double-edged swordObstructive shock explained: what's actually killing the patientRight ventricular failure, septal bowing, and the spiral of deathWhy intubation can worsen outcomes in massive PEVasopressors in PE: norepinephrine, epinephrine, and vasopressinThe unique benefits of vasopressin in obstructive shockThrombolysis vs. thrombectomy: when TPA helps — and when it's deadlyBedside echo findings that point to massive PEWhy PE patients can crash during transport (and what to always bring)Nursing vigilance, rapid escalation, and activating help earlyWhen perfect care still isn't enough and the heart of nursing in end-of-life momentsMentioned in this episode:CONNECT

Broadcast from KSQD, Santa Cruz on 12-18-2025: Dr. Dawn opens by examining how market competition is actually working in the weight loss drug sector. Novo Nordisk's Ozempic and Wegovy compete against Eli Lilly's Monjaro and ZepBound, with prices dropping nearly 50% as companies launch direct-to-consumer websites. The main barriers remain needles and refrigeration, driving development of oral versions. Novo's Wegovy pill awaits FDA approval for early 2026 launch at $150 monthly. Next-generation drugs show remarkable results: Eli's retatrutide causes 24% weight loss in 48 weeks, while Novo's Cagrisema combines semaglutide with amylin to reduce muscle loss. Pfizer paid $10 billion for Metsera's once-monthly drug despite significant side effects. A quick fiber tip suggests adding plain psyllium to morning coffee for cardiovascular and microbiome benefits. Start with half a teaspoon and work up to two teaspoons (10 grams) over several weeks to avoid gas. The prebiotic fiber improves glucose tolerance and may reduce cancer risk. UC San Diego scientists discovered why cancers mutate so rapidly despite being eukaryotic cells with protected chromosomes. The answer is chromothripsis, a catastrophic event where the enzyme N4BP2 literally explodes chromosomes into fragments. These reassemble incorrectly, generating dozens to hundreds of mutations simultaneously and creating circular DNA fragments carrying cancer-promoting genes. One in four cancers show evidence of this mechanism, with all osteosarcomas and many brain cancers displaying it. This explains why the most aggressive cancers resist treatment. Research from 2013 shows any glucocorticoid use significantly increases venous thromboembolism risk, with threefold increases during the first month of use. The risk applies to new and recurrent clots, affecting both oral and inhaled steroids, though IV poses highest risk and topical the lowest. Joint injections fall somewhere between inhaled and oral. Anyone with prior blood clots should avoid steroids except for life-threatening situations like severe asthma attacks requiring ventilation. A meta-analysis of 20 randomized controlled trials shows creatine supplementation helps older adults (48-84) maintain muscle mass when combined with weight training two to three times weekly. The supplement provides no benefit without exercise. Recommended dosing starts at 2 grams and works up to 5 grams daily. Vegans benefit most since they consume little meat or fish. Important caveat: creatine throws off standard kidney function tests (creatinine), so users should request cystatin C testing instead for accurate renal health assessment. A new JAMA study suggesting risk-based mammogram screening is fatally flawed. First, researchers offered chemopreventative drugs like tamoxifen only to the high-risk group, contaminating the study design. Second, the demographics skewed heavily toward white college-educated women, missing the reality that Black women face twice the risk of aggressive breast cancer with 40% higher mortality. Third, wild-type humans failed to follow instructions—low-risk women continued getting annual mammograms anyway while high-risk women skipped recommended extra screenings. The conclusion of "non-inferior" outcomes is meaningless given poor adherence. Stick with annual mammograms, and consider alternating with MRIs for high-risk women. The EAT-Lancet report condemns red meat based purely on observational data showing correlations with heart disease, cancer, and mortality. But people who eat lots of red meat differ dramatically from low consumers: they weigh more, smoke more, exercise less, and eat less fiber. Studies can't control for sleep quality, depression, or screen time. Notably, heavy meat eaters also die more in accidents, suggesting a risk-taking lifestyle phenotype. The inflammatory marker TMAO is higher in meat eaters, but starch is also pro-inflammatory. Eating red meat instead of instant ramen might improve health. A balanced diet with limited amounts beats epidemiology-based blanket statements. Dr. Dawn grades Dr. Oz's performance as CMS administrator. Starting at minus one for zero relevant experience, he earns plus two for promoting diet, exercise, and gut health on his show. He studied intensively after nomination, calling all four previous CMS directors repeatedly and surrounding himself with experienced staff (plus one). He finalized Medicare rules favoring prevention over surgery and earned bipartisan praise as "a real scientist, not radical" (plus one). He divested healthcare holdings but kept some blind trust interests (minus 0.5). He's developing a CMS app and partnering with Google on a digital health ecosystem (plus one), but supports ending ACA subsidies that will raise premiums for millions (minus one). He correctly promoted COVID vaccines and contradicted Trump's Tylenol-autism claims (plus one). Final score: 3.5 out of 5 possible points, the only positive score for any Trump health administrator.

Venous Thromboembolism refers to the presence of blood clots in veins, in particular deep vein thrombosis and pulmonary embolism. We cover both, including Virchow's Triad and the pathophysiology of pulmonary embolism. Also included are the signs and symptoms of pulmonary embolism and deep vein thrombosis, as well as the diagnosis and treatment of both. PDFs available here: https://rhesusmedicine.com/pages/respiratoryConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Venous Thromboembolism?0:32 Normal Cardiac and Pulmonary Circulation 0:59 Deep Vein Thrombosis Pathophysiology (& Most Common Veins)1:24 Pulmonary Embolism Pathophysiology 3:52 Venous Thromboembolism Pathophysiology (Virchow's Triad)5:32 Signs and Symptoms of Deep Vein Thrombosis5:49 Signs and Symptoms of Pulmonary Embolism6:25 Venous Thromboembolism Diagnosis8:18 Pulmonary Embolism ECG Findings8:53 Treatment of Deep Vein Thrombosis / Pulmonary EmbolismLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesStone, J., Hangge, P., Albadawi, H., Wallace, A., Shamoun, F., Grace Knuttien, M., Naidu, S. & Oklu, R., 2017. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovascular Diagnosis and Therapy, 7(Suppl 3), pp.S276–S284. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5778510/. PubMed CentralMSD Manuals Professional, 2025. Pulmonary embolism (PE) – Pulmonary Disorders. [online] Available at: https://www.msdmanuals.com/professional/pulmonary-disorders/pulmonary-embolism/pulmonary-embolism-pe.Turetz, M., Sideris, A.T., Friedman, O.A. & Triphathi, N., 2018. Epidemiology, pathophysiology, and natural history of pulmonary embolism. Seminars in Interventional Radiology. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986574/. PubMed CentralMSD Manuals Professional, 2025. Deep Venous Thrombosis (DVT) – Cardiovascular Disorders / Peripheral Venous Disorders. [online] Available at: https://www.msdmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt.Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

In this episode of ACEP Nowcast, host Amy Faith Ho, MD, MPH, FACEP, interviews Nirajan Nepal, MD, to discuss pulmonary embolism after routine peripheral intravenous catheter insertion, and reminds us that routine is only routine until it is not. We also touch on life in military medicine. Read the full case report at ACEPNow.com. More links: Read more on ACEPNow.com. Revisit ACEP Nowcast podcast episodes.  View job opportunities at emCareers.

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? USMLE Step 1 Ad-Free Bundle Crush Step 1 Step 2 Secrets Beyond the Pearls The Dr. Raj Podcast Beyond the Pearls Premium USMLE Step 3 Review MedPrepTGo Step 1 Questions MedPrepTGo Step 2 Questions Learn more about your ad choices. Visit megaphone.fm/adchoices

Most people assume that if you've ever had a blood clot, plastic surgery is off the table forever.But is that actually true?In this powerful episode of Plastic Surgery Uncensored, Dr. Rady Rahban sits down with Lori — a 60-year-old woman who survived multiple blood clots, including two pulmonary embolisms, and still safely underwent a tummy tuck.This conversation dives into:The real risks of surgery after DVT or PEWhy most doctors automatically say no — and why sometimes, that's not the whole storyHow a true team approach between surgeon + hematologist can make previously “impossible” cases possibleThe emotional journey of choosing your own quality of life — even when others try to talk you out of itThis is not a story about vanity.  It's a story about courage, medical nuance, and reclaiming your confidence at any age. If you've ever wondered, “Can I have plastic surgery if I've had a blood clot?” — this episode is your answer.✨ If you enjoyed this episode of Plastic Surgery Uncensored:✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.✔️ Rate & Review—your feedback helps more people find us.✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:Instagram: @drradyrahbanTikTok: @radyrahbanMDYouTube: @Rady RahbanFacebook: @Rady Rahban✔️ Share this episode with someone considering plastic surgery—the right knowledge can save a life.

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? USMLE Step 1 Ad-Free Bundle Crush Step 1 Step 2 Secrets Beyond the Pearls The Dr. Raj Podcast Beyond the Pearls Premium USMLE Step 3 Review MedPrepTGo Step 1 Questions MedPrepTGo Step 2 Questions Learn more about your ad choices. Visit megaphone.fm/adchoices

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? USMLE Step 1 Ad-Free Bundle Crush Step 1 Step 2 Secrets Beyond the Pearls The Dr. Raj Podcast Beyond the Pearls Premium USMLE Step 3 Review MedPrepTGo Step 1 Questions MedPrepTGo Step 2 Questions Learn more about your ad choices. Visit megaphone.fm/adchoices

About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. More from Dr. Raj The Dr. Raj Podcast Dr. Raj on Twitter Dr. Raj on Instagram Want more board review content? USMLE Step 1 Ad-Free Bundle Crush Step 1 Step 2 Secrets Beyond the Pearls The Dr. Raj Podcast Beyond the Pearls Premium USMLE Step 3 Review MedPrepTGo Step 1 Questions MedPrepTGo Step 2 Questions Learn more about your ad choices. Visit megaphone.fm/adchoices

We review the diagnosis, risk stratification, & management of acute pulmonary embolism in the ED. Hosts: Vivian Chiu, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Acute_Pulmonary_Embolism.mp3 Download Leave a Comment Tags: Pulmonary Show Notes Core Concepts and Initial Approach Definition: Obstruction of pulmonary arteries, usually from a DVT in the proximal lower extremity veins (iliac/femoral), but may be tumor, air, or fat emboli. Incidence & Mortality: 300,000–370,000 cases/year in the USA, with 60,000–100,000 deaths annually. Mantra: “Don't anchor on the obvious. Always risk stratify and resuscitate with precision.” Risk Factors: Broad, including older age, inherited thrombophilias, malignancy, recent surgery/trauma, travel, smoking, hormonal use, and pregnancy. Clinical Presentation and Risk Stratification Presentation: Highly variable, showing up as anything from subtle shortness of breath to collapse. Acute/Subacute: Dyspnea (most common), pleuritic chest pain, cough, hemoptysis, and syncope. Patients are likely tachycardic, tachypneic, hypoxemic on room air, and may have a low-grade fever. Chronic: Can mimic acute symptoms or be totally asymptomatic. Pulmonary Infarction Signs: Pleuritic pain, hemoptysis, and an effusion. High-Risk Red Flags: Signs of hypotension (systolic blood pressure < 90 mmHg for over 15 minutes),

Get Nursing Study Guides, NCLEX Tools, & More: https://nursestudynet.shop/Download my Audiobook Version for FREE If you love listening to audiobooks on-the-go, you can download the audiobook version of our NCLEX Prep book for FREE (Regularly $19.95) just by signing up for a FREE 30-day audible trial!Get this book for FREE when you sign up for a 30-day free-trial with Audible Audible US: https://bit.ly/42j6grx Audible UK: https://bit.ly/3Sp7SLN Audible FR : https://bit.ly/3UnJeOb Audible Canada : https://bit.ly/4bxh7T1 ___________________________________________See all of our FREE Nursing Exams onlineGet a FREE Copy of Pass The NCLEXVisit NurseStudy.Net we have over 800 Nursing care plans available.Nursing ResourcesRecommended NCLEX Nursing School Review ProgramNCLEX Review ProgramRecommended BooksLab Values for Nurses Over 160 Test QuestionsFundamentals of Nursing Review 110 Test QuestionsFluids and Electrolytes 100 Test QuestionsNursing Diagnosis HandbookNursing Care Plans HandbookMedical Surgical NursingComprehensive NCLEX Review*Social*Web: https://nursestudy.net/Shop: https://amzn.to/36jrZCNInstagramFacebookPinterestTikTokThe description contains affiliate links and I may be compensated a small amount if you make a purchase after clicking on my links.DisclaimerThis lesson is not intended to provide medical advice. The articles on this website are intended for entertainment or educational value only. While we strive to offer 100% accuracy, we cannot guarantee the validity or accuracy of any content. Medical procedures are rapidly changing, and laws vary greatly from location.  #NCLEX #Nursing #NursingStudentSupport the show

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In this episode of The Radiology Review Podcast, we cover pulmonary embolism (PE), an essential diagnosis to master for the radiology boards and for clinical practice. This high-yield review highlights imaging findings, pitfalls, and pearls across modalities, with a focus on CT pulmonary angiography (CTPA). Check out the free study guide on this episode at theradiologyreview.com. Useful Resources & LinksDiscounts to Boost Your Study ToolsExplore current savings for radiology learning resources:BoardVitals: 10% off with RADREVIEW; $100 off CME with RADREVIEW100.Medality/MRI Online: 10% off with code radreview.(Offers may vary by date—check the linked page for the latest) The Radiology ReviewView all available offers →The Radiology Review Insider (RRI)The RRI is free-access, non-peer-reviewed content authored by thought leaders. It includes perspectives on radiology education, personal essays, board-prep advice, and workflow strategies—great for expanding your understanding beyond cases. Learn more about the RRJ →Radiologist Gear GuideImprove your workstation ergonomics and productivity with tools like ergonomic mice, programmable keypads, studio microphones, and foot pedals—selected to streamline your reading-room workflow. Explore recommended gear →Mentioned in this episode:Board VitalsRadiology residents—get ready for the ABR CORE Exam with BoardVitals! Access over 1,300 high-yield questions, detailed explanations, and adaptive learning. Study anytime with the mobile app, customize by subject, and track progress. Plus, a 100% pass guarantee! Start your free trial at BoardVitals.com and use code RADREVIEW for 10% off Radiology question banks.

In this episode, Dr. Linda Chu explores a major Radiology consensus statement on optimizing CT angiography for suspected pulmonary embolism. The discussion covers advanced imaging techniques, key considerations for special populations, and standardized reporting practices to improve diagnostic clarity and patient outcomes. Optimal Approach to Performing and Reporting ComputedTomography Angiography for Suspected Acute PulmonaryEmbolism: A Clinical Consensus Statement of the ESC Working Groupon Pulmonary Circulation & Right Ventricular Function, the FleischnerSociety, the Association for Acute Cardiovascular Care (ACVC) andthe European Association of Cardiovascular Imaging (EACVI) of theESC, Endorsed by European Respiratory Society (ERS), Asian Societyof Thoracic Radiology (ASTR), European Society of Thoracic Imaging(ESTI), and Society of Thoracic Radiology (STR). Radiology 2025; 315(3):e243833.

In this episode of the Saving Lives Podcast, we review a comprehensive 2025 meta-analysis on mortality risk factors in pulmonary embolism. Learn which clinical signs, biomarkers, and imaging findings most strongly predict outcomes — and how they can guide triage and therapy decisions in acute PE cases. A must-listen for anyone managing thromboembolic disease in the critically ill patients.The Vasopressor & Inotrope HandbookAmazon: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/47qJZe1⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Affiliate Link)My Store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://eddyjoemd.myshopify.com/products/the-vasopressor-inotrope-handbook⁠⁠⁠⁠⁠⁠⁠⁠⁠ (Use "podcast" to save 10%)Citation: You W, Fan XY, Chen Y, Wang XL, Song J, Nie CC, Dong Q. Risk Factors for Mortality in Patients with Pulmonary Embolism-A Meta-Analysis. J Intensive Care Med. 2025 May 5:8850666251326539. doi: 10.1177/08850666251326539. Epub ahead of print. PMID: 40320917.

Near-death experience guest 1433 is Jen Crowe who had a near death experience due to a massive bi-lateral pulmonary embolism and ended up in the “in-between “. CONTACT:Email: jeff@jeffmarapodcast.comTo donate crypto:Bitcoin - bc1qk30j4n8xuusfcchyut5nef4wj3c263j4nw5wydDigibyte - DMsrBPRJqMaVG8CdKWZtSnqRzCU7t92khEShiba - 0x0ffE1bdA5B6E3e6e5DA6490eaafB7a6E97DF7dEeDoge - D8ZgwmXgCBs9MX9DAxshzNDXPzkUmxEfAVEth. - 0x0ffE1bdA5B6E3e6e5DA6490eaafB7a6E97DF7dEeXRP - rM6dp31r9HuCBDtjR4xB79U5KgnavCuwenWEBSITEwww.jeffmarapodcast.comSOCIALS:Instagram: https://www.instagram.com/jeffmarapodcast/Facebook: https://www.facebook.com/jeffmarapodcast/Twitter: https://www.twitter.com/jeffmaraP/The opinions of the guests may or may not reflect the opinions of the host.

In this episode, Drs. Vivian Bishay, Wissam Jaber and Dr. Vlad Lakhter review safety, patient selection, and risk stratification related to device selection. They examine the economics of outcomes in PE treatment, including workflow efficiency and the impact of avoiding post-procedure infusion and ICU resource use. Discussion ensues on the role of treatment location, ease of use, and how broader access to technology may influence care delivery.

On this month's EM Quick Hits podcast: Dr. Mathew MacArther on Occipital Nerve Block, Dr. Ian Chernoff on PoCUS in Pulmonary Embolism, Dr. Hans Rosenberg on Myelopathy, Dr. Shawn Segeren on Team Resuscitation, Dr. Brit Long on Incidental Neutropenia and Dr. Kylie Booth on Peer Programs. Please help ensure continued Free Open Access of the entire EM Cases Learning System by donating here: https://emergencymedicinecases.com/donation/

Podcast summary of articles from the April 2025 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include ECGs in cardiac arrest, strep toxic shock syndrome, diabetic ketoacidosis, chest pain work ups, exertional heat stroke, and pulmonary embolism controversies.  Guest speaker is Dr. Matthew Carvey.

There are many nuances in the management of patients with pulmonary embolism in cardiac arrest, peri-arrest or simply in shock: We need to optimize oxygenation and airway management, hemodynamic support, acid/base management, thrombolysis and/or catheter-directed therapies that Anton dives into with guest experts Dr. Lauren Westafer, Dr. Bourke Tillmann and Dr. Justin Morgenstern... EM Cases is proudly FOAMEd - Please consider a donation: https://emergencymedicinecases.com/donation/

CardioNerds Critical Care Cardiology Council members Dr. Gurleen Kaur and Dr. Katie Vanchiere meet with Dr. Yash Patel, Dr. Akanksha, and Dr. Mohammed El Nayir from Trinity Health Ann Arbor. They discuss a case of pulmonary air embolism, RV failure, and cardiac arrest secondary to an ocular venous air embolism. Expert insights provided by Dr. Tanmay Swadia. Audio editing by CardioNerds Academy intern, Grace Qiu. A 36-year-old man with a history of multiple ocular surgeries, including a complex retinal detachment repair, suffered a post-vitrectomy collapse at home. He was found hypoxic, tachycardic, and hypotensive, later diagnosed with a pulmonary embolism from ocular venous air embolism leading to severe right heart failure. Despite a mild embolic burden, the cardiovascular response was profound, requiring advanced hemodynamic support, including an Impella RP device (Abiomed, Inc.). Multidisciplinary management, including fluid optimization, vasopressors and mechanical support to facilitate recovery. This case underscores the need for early recognition and individualized intervention in cases of ocular venous air embolism. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls- Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest Hypoxia, hypotension and tachycardia in a patient following ocular instrumentation are classic findings suggestive of pulmonary embolism from possible air embolism. The diagnosis of RV failure is based on clinical presentation, echocardiographic findings (such as McConnell's sign), and invasive hemodynamic assessment via right heart catheterization. Mechanical circulatory support can be considered as a temporary measure for patients with refractory RV failure. Central Figure: Approach to Pulmonary Embolism with Acute RV Failure Notes - Clear Vision, Clouded Heart: Ocular Venous Air Embolism with Pulmonary Air Embolism, RV Failure, and Cardiac Arrest 1. What is an Ocular Venous Air Embolism (VAE), and how can it be managed in critically ill patients? An Ocular Venous Air Embolism is defined as the entry of air into the systemic venous circulation through the ocular venous circulation, often during vitrectomy procedures. Early diagnosis is key to preventing cardiovascular collapse in cases of Ocular Venous Air Embolism (VAE).  The goal is to stop further air entry. This can be done by covering the surgical site with saline-soaked dressings and checking for air entry points. Adjusting the operating table can help, especially with a reverse Trendelenburg position for lower-body procedures. The moment VAE is suspected, discontinue nitrous oxide and switch to 100% oxygen. This helps with oxygenation, speeds up nitrogen elimination, and shrinks air bubbles. Hyperbaric Oxygen Therapy can reduce bubble size and improve oxygenation, especially in cases of cerebral air embolism, when administered within 6 hours of the incident. Though delayed hyperbaric oxygen therapy can still offer benefits, the evidence is mixed. VAE increases right heart strain, so inotropic agents like dobutamine can help boost cardiac output, while norepinephrine supports ventricular function and systemic vascular resistance, but this may also worsen pulmonary resistance.  Aspiration of air via multi-orifice or Swan-Ganz catheters has limited success, with success rates ranging from 6% to 16%. In contrast, the Bunegin-Albin catheter has shown more promise, with a 30-60% success rate. Catheterization for acute VAE-induced hemodynamic compromise is controversial, and there's insufficient evidence to support its ...

Dr. Allison Greco, pulmonary and critical care specialist at Bellevue Hospital, sits down with Dr. Emily Gutowski and discusses the initial presentation, workup, and management of a patient with a pulmonary embolism. They go through diagnostic modalities, scoring systems, and the various treatment options for patients depending on their risk profile. They discuss provoked vs. unprovoked PEs, and recommendations for longer term anticoagulation.

How do you predict which intermediate-risk patients will suddenly deteriorate? What role do risk scores, biomarkers, imaging, and hemodynamics play in decision-making? Should these patients receive anticoagulation alone, or is thrombolysis warranted? When should you consider catheter-directed or surgical interventions? This podcast focuses us to think critically about risk stratification, early interventions and escalation in care in PE. We include an algorithm in the show notes. Not all patients fit neatly into classification boxes, making clinical judgment crucial. Join Dr. Lauren Westafer, Dr. Justin Morgenstern, Dr. Bourke Tillman and Anton as they explore the key decision points, pitfalls, and lifesaving strategies for managing intermediate-risk PE in the ED...

For this episode we are joined by EBM guru, Dr. Brian Locke, who deftly breaks down all of our statistics questions. Is half dose DOAC as good as full dose DOAC for preventing VTE, and does it reduce bleeding risk? Can procalcitonin reduce duration of antibiotics for infections without compromising mortality rates? Can LLMs like GPT-4 help physicians manage patients better? Can reinforcement learning models predict when to start vasopressin in patients with septic shock? What is the risk of resuming anticoagulation in patients with atrial fibrillation and prior intracerebral hemorrhage? Is high flow nasal cannula as good as non-invasive ventilation for different types of respiratory failure? We answer all these questions and more!Half Dose DOAC for Long Term VTE Prevention (RENOVE)Biomarker-Guided Antibiotic Duration (ADAPT-Sepsis)GPT-4 Assistance for Physician PerformanceOptimal Vasopressin Initiation for Septic Shock (OVISS)DOACs for A fib after ICH (PRESTIGE-AF)High Flow Nasal Cannula vs NIV for Respiratory Failure (RENOVATE)Music from Uppbeat (free for Creators!): https://uppbeat.io/t/soundroll/dope License code: NP8HLP5WKGKXFW2R

Blood clots can be life-threatening, but understanding their causes and treatments can save lives. In Part 2 of our Hematology Series, Dr. Andrew Jenzer, DDS, dives deep into thrombosis, breaking down the three key contributing factors and the most common hypercoagulable conditions. We carefully dissect the pathophysiology of pulmonary embolisms, the most important guidelines to know and follow, the difference between provoked and unprovoked hypercoagulable conditions, and everything you need to know about the perioperative management of antithrombotic therapies. To close, Dr. Jenzer highlights the critical risk factors of preoperative anticoagulation and key takeaways from our conversation that should never be forgotten. If you're a healthcare professional or simply someone who values life-saving knowledge, this episode is packed with insights you won't want to miss. Tune in to sharpen your expertise and improve patient outcomes!Key Points From This Episode:Three contributors to thrombosis and the most common hypercoagulable conditions.Unpacking the pathophysiology of pulmonary embolisms.Wells' Criteria, CHEST, and other crucial guidelines to follow. The difference between provoked and unprovoked hypercoagulable conditions.  Anticoagulation therapies and important surgical considerations.Risk factors associated with the perioperative management of antithrombotic therapy. Recapping the key takeaways from today's conversation. Links Mentioned in Today's Episode:Dr. Andrew Jenzer Email — andrew.jenzer@gmail.com Dr. Andrew Jenzer | Duke Surgery — https://surgery.duke.edu/profile/andrew-clark-jenzer  ACOMS | Annual Winter Meeting — https://www.acoms.org/Events/Winter-Meeting/About Wells' Criteria for Pulmonary Embolism — https://www.mdcalc.com/calc/115/wells-criteria-pulmonary-embolism Wells' Criteria for DVT — https://www.mdcalc.com/calc/362/wells-criteria-dvt  American College of Chest Physicians — https://www.chestnet.org/  ‘Perioperative Management of Antithrombotic Therapy' — https://www.chestnet.org/guidelines-and-topic-collections/guidelines/pulmonary-vascular/perioperative-management-of-antithrombotic-therapy  ‘Perioperative Management of Patients with Atrial Fibrillation Receiving a Direct Oral Anticoagulant' — https://pubmed.ncbi.nlm.nih.gov/31380891/  ‘Perioperative Optimization and Management of the Oral and Maxillofacial Surgical Patient' — https://pubmed.ncbi.nlm.nih.gov/38103577/ Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720-441-6059

A pulmonary embolism is a condition in which vessels in the lungs are blocked by a thrombus or other material that has traveled from somewhere else in the body. This is usually a result of a venous thromboembolism, but can also be due to amniotic fluid, air or fat embolus, or tumor material in patients with cancer. A key thing to understand about pulmonary embolism is that the airway is not occluded. In pulmonary embolism, one or more blood vessels are occluded. What this means is that blood coming from the right side of the heart isn't able to pass freely through the pulmonary vasculature to participate in gas exchange, which negatively affects perfusion. In this episode you'll learn: Pulmonary embolism pathophysiology Which of your patients are at highest risk for having a PE Common signs and symptoms of PE Priority nursing assessments Tests utilized to evaluate or diagnose PE Treatments for PE, including pharmacological and surgical And more! Hit play on this episode so you can understand how to recognize PE quickly so your patient can have their best chance at recovery. ___________________ Full Transcript - Read the article and view references FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! Med Surg Solution - Are you looking for a more effective way to learn Med Surg? Enroll in Med Surg Solution and get lessons on 57 key topics and out-of-this-world study guides.  Straight A Nursing App - Study on-the-go with the Straight A Nursing app! Review more than 5,000 flashcards covering a wide range of subjects including Fundamentals, Pediatrics, Med Surg, Mental Health, Maternal Newborn, and more! Available for free in the Apple App Store and Google Play Store. LATTE Method Template - Download the free LATTE Method Template so you can streamline how you study and focus on what a nurse needs to know.  20 Secrets of Successful Nursing Students – Learn key strategies that will help you be a successful nursing student with this FREE guide!