Back in RAGE Session Two we discussed ‘Thrombolysis for Submassive Pulmonary Embolus’. This was actually just before the PEITHO trial was published, though we were able to anticipate many of the findings thanks to the wonders of the web.
A great follow up to our discussion is EMCrit Podcast 128 – Pulmonary Embolism Treatment Options and the PEAC Team with Oren Friedman. This discussion reiterates many of the conclusions the RAGE team came to, with additional discussions about catheter-directed thrombolysis and reduced dose thrombolysis.
Meanwhile, the NEJM has just published correspondence in response to the PEITHO trial -it includes a comment about half-dose thrombolysis by Rory Spiegel, myself and Ryan Radecki.
The wait is over, RAGE Session Two is here!
RAGE Session Two is 80 min 19 sec long and includes:
- Introduction, including some bad news… (starts 00:00 min)
- ‘What’s bubbling up?’ (starts 00:58 min) — shout outs and interesting discoveries from the world of FOAM and elsewhere featuring codeine in kids, post-intubation sedation, adenosine versus verapamil for SVT and how to do a good vagal manoeuvre, the ETM Twitter fiasco, the FOAMcc Google Plus Community and smaccGOLD.
- the RAGE team discussing a case of submassive pulmonary embolism and the role of thrombolysis (starts 22:14 min)
- the RAGE team’s discussion on ‘Humans in the resus room: ‘when your back-up gets your back up’’ (starts 51:50 min)
- ‘A blast from the past’ on WW2 hero and chain-smoking legend Edgar Patz, the only man to complete an entire Masters degree unconscious! (starts 73:00 min)
- ‘Wise Words’ featuring the art of observation, the immortal John Hunter and the infinitely wise Sir William Osler (starts 77.55 min)
The RAGE podcast is on iTunes here and the RAGE podcast audio feed is available here.
Here are the show notes for RAGE Session Two:
What’s bubbling up?
Submassive Pulmonary Embolus and Thrombolysis
- Dresden S,et al. Right ventricular dilatation on bedside echocardiography performed by emergency physicians AIDS in the diagnosis of pulmonary embolism. Ann Emerg Med. 2014 Jan;63(1):16-24. doi: 10.1016/j.annemergmed.2013.08.016. Epub 2013 Sep 27. PubMed PMID: 24075286.
- Kline JA, Steuerwald MT, Marchick MR, Hernandez-Nino J, Rose GA. Prospective evaluation of right ventricular function and functional status 6 months after acute submassive pulmonary embolism: frequency of persistent or subsequent elevation in estimated pulmonary artery pressure. Chest. 2009 Nov;136(5):1202-10. doi: 10.1378/chest.08-2988. Epub 2009 Jun 19. PubMed PMID: 19542256; PubMed Central PMCID: PMC2818852.
- Howard LS. Thrombolytic therapy for submassive pulmonary embolus? PRO viewpoint. Thorax. 2014 Feb;69(2):103-5. doi: 10.1136/thoraxjnl-2013-203413. Epub 2013 Apr 26. PubMed PMID: 23624534.
- Konstantinides S, Geibel A, Heusel G, Heinrich F, Kasper W; Management Strategies and Prognosis of Pulmonary Embolism-3 Trial (MAPPET-3) Investigators. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med. 2002 Oct 10;347(15):1143-50. PubMed PMID: 12374874. [Free Full Text]
- Sharifi M, et al; “MOPETT” Investigators. Moderate pulmonary embolism treated with thrombolysis (from the “MOPETT” Trial). Am J Cardiol. 2013 Jan 15;111(2):273-7. doi: 10.1016/j.amjcard.2012.09.027. Epub 2012 Oct 24. PubMed PMID: 23102885.
- Simpson AJ. Thrombolysis for acute submassive pulmonary embolism: CON viewpoint. Thorax. 2014 Feb;69(2):105-7. doi: 10.1136/thoraxjnl-2013-204193. Epub 2013 Sep 17. PubMed PMID:24046127.
Humans in the Resus Room: ‘When your Back-Up gets your Back Up’
Blast from the Past
Words of Wisdom
Thanks again for listening to the RAGE!
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