In patients with partial nail avulsion with preserved nail structure, and without laceration or fracture, should I remove the nail?
No: the remaining nail acts as a protective splint for the underlying nail bed and holds the nail fold open, which may take 60-170 days. Use a digital block followed by copious betadine/water and soak the hand. Explore the margins, find the intact nail fold and reapproximate the nail. You may also need to explore …
Can I use the age adjusted D-dimer in clinical practice? If so, how?
The ADJUST PE trial is hot off the JAMA presses in March 2014. The takehome: of 1141 patients excluded from scanning by clinical assessment plus age adjusted d-dimer, there were only 2 cases of non-fatal PE (0.2%). Of these 1141 patients, 331 had an age adjusted d-dimer greater than the standard cutoff of 500mg/mL. Of these …
CHF or PE? PE is a known and common complication of CHF
challenging case: an obese 60yo patient never seen by a doctor as an adult presents marked peripheral edema, hypertension, and 2 months of worsening DOE, PND, orthopnea. BNP 400, EKG Unremarkable, trop 0.1, stating well. It feels like CHF. But the cardiologist wants a CTPE. We oblige – big saddle embolus with RV strain. This …