In a festive twist for Valentine’s Day, hosts explore the PERC-35 rule for diagnosing pulmonary embolism in younger patients, highlighting key studies and their implications. They also dive into guidelines for handling glucocorticoid-induced adrenal insufficiency, emphasizing the complexities faced by healthcare professionals. Discussions include the challenges of serum glucocorticoid management in emergencies and the vital importance of careful monitoring. Lastly, they touch on pediatric care insights, particularly on dehydration assessment and evaluating pregnant patients.
The podcast discusses the PERC 35 rule, emphasizing the need for accurate pulmonary embolism assessment in patients under 35 due to varying presentation.
Guidelines on managing glucocorticoid-induced adrenal insufficiency are introduced, highlighting the critical need for awareness among emergency practitioners regarding at-risk patients.
New online resources are recommended, showcasing valuable articles for continuous professional development in emergency medicine, including consultant interview preparation and assessments for unique patient populations.
Deep dives
Dry January and Valentine's Day
The hosts celebrate the end of Dry January, highlighting the communal sense of achievement for those who participated in it. A playful discussion ensues about Valentine’s Day plans, indicating a lighthearted approach to personal relationships and the significance of the occasion. They share that despite being in a committed marriage, one host humorously admits to forgetting Valentine's Day, while the other nonchalantly recounts their own lack of plans. This conversation hints at the balance of personal life and professional demands, establishing a relatable connection with the audience.
PERC 35 Rule and Pulmonary Embolism
The episode discusses the PERC 35 rule, designed to assess the risk of pulmonary embolism (PE) in younger patients, suggesting that it may provide useful guidance in this demographic. Findings from the RITA registry indicate that the original PERC rule, developed for older individuals, may not be optimally applicable to those under 35 years of age due to differences in how PE presents in younger patients. Data reveal that while the PERC 35 rule shows a low overall failure rate for PE detection, it resulted in higher missed rates compared to accepted standards when applied specifically to younger patients. The conversation emphasizes the need for validation of the PERC 35 rule through prospective studies, underlining the importance of accurate risk assessment in emergency medicine.
Understanding Adrenal Insufficiency
The podcast introduces a guideline on managing glucocorticoid-induced adrenal insufficiency relevant to emergency departments by distinguishing between endocrine and non-endocrine patients undergoing steroid therapy. It emphasizes the critical role that glucocorticoids play in maintaining the body’s response to stress, and the potential life-threatening consequences when patients experience adrenal crises due to inadequate steroid coverage. The discussion covers preventative strategies for identifying at-risk populations, stressing the importance of awareness among emergency practitioners regarding patients on long-term steroid therapy. Recommendations highlight the need for clinicians to educate patients about their glucocorticoid therapy and ensure appropriate dosing during periods of stress or illness.
Emergency Treatment of Adrenal Crisis
A focus on the emergency management of adrenal crisis details the symptoms, risks, and necessary immediate interventions for patients experiencing severe adrenal insufficiency. The appropriate treatment includes administering parenteral hydrocortisone and fluid resuscitation to stabilize affected individuals and prevent fatal outcomes. The podcast underscores the significance of having preemptive measures in place during emergencies, especially for patients known to require glucocorticoid therapy. The discussion notes a potential gap in emergency protocols regarding the assessment and management of patients at risk for adrenal insufficiency during procedures, prompting further reflection and improvement within emergency care frameworks.
New Resources and Further Learning
The episode features recommendations for new healthcare resources, highlighting articles that provide valuable insights into urgent topics such as consultant interview preparation and assessing dehydration in children. It introduces a comprehensive piece on the medical assessment of pregnant patients in emergency departments, reflecting a need for improved understanding and management of unique patient populations. The hosts encourage continued learning and engagement with these resources as part of continuous professional development. This segment reaffirms the commitment to lifelong learning in emergency medicine and the necessity of up-to-date knowledge to enhance patient care.
Happy Valentine's Day! This month for the February 2025 episode of the RCEM Learning Podcast, we have got a new in EM segments looking at the assessment of PE in younger patients. Becky and Chris detail a guideline on acute adrenal insufficiency, before ending with New Online. If you'd like to email us, please feel free to do so here. After listening, complete a short quiz to have your time accredited for CPD at the RCEMLearning website!
