Anand Swaminathan

Bio

Anand “Swami” Swaminathan is a New Jersey native who completed his Emergency Medicine training at Bellevue Hospital in New York City, where he stayed on as faculty. He is a big supporter of FOAM and uses it to cut knowledge translation. Swami is the creator of the Core EM (coreem.net) project which seaks to increase the amount of core content FOAM available to trainees. Outside of EM, he enjoys distance running and building Legos with his kids: Matt, 7, Maya, 4 and Luke 1.

@EMSwami


Thin-Slicing in the ED

All disease exist on a spectrum. You can’t treat one end of the spectrum the same way you treat the other end.
All diseases exist on a spectrum. Although the pathophysiology and relative illness of patients on the spectrum are different, we often apply the concepts of management of one of the spectrum to the other end. This can be extremely deleterious to our patients. For example, we cannot treat CHF exacerbations, acute pulmonary edema and cardiogenic shock with the same approach (i.e. no role for loop diuretics early in APE). Thin-slicing disease into a spectrum allows us to tailor our management to our patients and maximize good outcomes.

Submassive PE should be thrombolysed - Pro

Patients with submassive PE should be considered for thrombolysis in order to improve functional outcomes

PE is a spectrum of disease and patients on different parts of the spectrum should be treated differently. Subsegmental PE may need no treatment at all whereas massive PE is unlikely to improve without lytics. Between these ends of the spectrum lies the submassive PE – hemodynamically stable but with signs of RV strain portending worse long-term functional outcomes for patients and possible early deterioration. These patients should all be considered for systemic thrombolysis to improve outcomes.


PE is a spectrum of disease and patients on different parts of the spectrum should be treated differently. Subsegmental PE may need no treatment at all whereas massive PE is unlikely to improve without lytics. Between these ends of the spectrum lies the submassive PE – hemodynamically stable but with signs of RV strain portending worse long-term functional outcomes for patients and possible early deterioration. These patients should all be considered for systemic thrombolysis to improve outcomes.



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