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If you missed Sohan’s last lecture as a resident, the June 4th  Journal Club, well, here’s a brief recap. For those of you who were there for his tour-de-force, you’ll no doubt want to refer to these notes from his talk in your future practice.

Sohan discussed the original PERC rule derivation paper and its recent validation — the papers below are accessible using our password system:

Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55. (PMID: 15304025)

Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772–80. (PMID: 18318689).

Sohan started with a lit review, going back to DeBakey’s 1954 discussion of 3 million PE’s, where it was first noted that PE is tough to diagnose and its prevalence is unclear. Even now, very little has changed. We don’t know the true incidence, we don’t know how many we miss, we don’t know which PE’s are clinically relevant, and we don’t know when to pursue this diagnosis. Even the Well’s criteria, which I mentioned here a couple of years ago, are not too clean — because they give more points to the physician’s judgment than to any other sign or lab result.

So we’ve been left with the unfortunate, all-to-common situation of considering D-dimers for every poor patient who presents with vague chest discomfort or dyspnea. If that dimer is positive, and it often is falsely so, we’re forced down a road of angiography , contrast, radiation, and other potential sources of morbidity.

Is there a way out of this? Is there a simple decision rule we can apply, at the bedside, using nothing but history and physical, to prevent this unnecessary testing?

Kline et al thought so — and the rule they proposed is discussed below.

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Please join us for conference on Wednesday, June 11th for a spectacular day of conference with our final Grand Rounds series of the academic year featuring four distinguished Grand Rounds lecturers. We will begin conference promptly at 9AM in Hatch Auditorium.

9am Grand Rounds: Pain Treatment in the ED: An Evidence-Based Approach - Dr. Stephen Thomas
10am Grand Rounds: Neurologic Emergencies: Tricks of the Trade - Dr. Greg Henry
11am Peds M&M - Dr. Vashi
12pm Grand Rounds: You’re a leader, Now what? Leadership lessons from the trenches - Dr. Shkelzen Hoxhaj
1pm Grand Rounds: Snake Bites; Evaluation and Management - Dr. Mike Rice

Please join us for Emergency Medicine Department Conference on 6/4 at 9AM at Elmhurst in the 8th floor conference room. This week’s conference covers topics ranging from academic to practical, with sessions that will change the way you practice and chart.

9am Journal Club - Dr. S Parekh (see previous entry for articles)
10am Billing and Coding Workshop - Dr. Phil Fairweather
12pm Core Lecture: Updates in Flank / GU Trauma - Dr. Amish Shah
1pm Senior Lecture - Dr. Spencer

Lunch will be provided.

Ted and Mark both gave their senior talks recently, and they mentioned a few useful clinical resources online that I thought were worth highlighting here.

The first is EM Peds,  Mark’s masterful new pediatric emergency medicine website. One-stop shopping for calculators, med options and dosing, clinical algorithms, and more. It’s found a permanent home now under this site’s ‘clinical’ tab, but check on it often.

Also,  Ted highlighted a bunch of sites worth visiting. He points us to the EM Foundation grant application page, the ACEP chapter grant page, and the guide to section grants. He also showed a list of awards available to EM residents, that I’m happy to share with you over email. There’s also this nifty SAEM website on resident resources.

For the teacher in all of us, visit residentteachers.org for some tips and videos on how to be a more effective educator. For the businessperson in all of us, consider the emcare conference for senior residents.

Journal Club on June 4th will feature articles on the PERC rule in the assessment of low risk patients with PE. The main article that we will review is the recent validation study and the supplementary article is the original derivation study. (Note that articles require passwords for download.)

Kline JA, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost 2008; 6: 772–80. (PMID: 18318689)

Kline JA, et al. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost 2004; 2: 1247–55. (PMID: 15304025)