Aug 14 2019: Eyes, finger lumps, PE and the D-dimer

EYES – LATERAL CANTHOTOMY (Dr Siva Gnanasekaran)
– to do in the setting of ocular compartment syndrome as a vision saving procedure
– doesn’t look hard!
– EM:RAP video on the procedure –
– video on the use of the tonopen –
– cut the SUPERIOR crus
– review plastics presentation on hand exam –
– remember to consider a broad ‘sieve’ (categories) to think about differentials when faced with an unexpected or unfamiliar finding eg. metabolic / trauma / neoplastic / vascular / inflammatory / toxin
– who remembers CREST?
PE and D-DIMER (Dr Romeo Restellini)
– read about the two-tier Well’s score for PE –
– if your suspicion for PE is high, anticoagulate FIRST
– thrombolysis for submassive PE is still controversial – involve ICU and respiratory EARLY
– suggestions from respiratory team that a regular inhaled steroid preventer improves outcomes although exact recommendation still hazy
– I am going to read the SYGMA 1 + 2 papers with interest and you should too:
– be wary of trials where significant conflict of interest exists
– We CAN however be BETTER at:
– asking about and documenting asthma frequency and severity and IMPACT – “what would you like to do but can’t, because of your asthma?”
– educating about asthma devices – patients might feel a spacer is no good because they don’t ‘feel’ the medication going in
– having multilingual resources for patient education – this is a potential PROJECT

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