Optimizing Emergency Diagnostic Imaging in Patients with Pulmonary Embolism in the Emergency Room

Summary We performed a retrospective evaluation of the criteria for suspected pulmonary embolism (PE) and requests for computed tomography angiography (CTA) by the emergency room (ER) teams. Simultaneously, we tried to find irregularities in their work. Then we designed new behavioral protocols, and yearly we evaluated the effect on the workload of the computed tomography (CT) unit of the Roentgenology and Radiology at the University Hospital – Pleven and the total impact on the behavior of the teams in cases of suspected for PE. The data from before and after the intervention was evaluated. After the implementation of the protocols, matching the criteria of PE rule-out criteria (PERC), the number of D-dimer testing, echocardiography, and computed tomography pulmonary angiographies (CTPA) was significantly higher. We found that the number of patients urgently transported for primary thrombectomy had increased, and the reduction of PE mortality in the Emergency Unit proves the safety of our intervention. Overall, the intervention in the attitude of the ER teams has a significant positive effect on the management of patients with suspected PE.

Anaesthesia for non-obstetric surgery

Anaesthesia for non-obstetric reasons is performed in 1–2% of all pregnant women. Although the chances of complications like miscarriage, preterm labour, and abortion are higher when surgery is performed during gestation, careful evaluation, preparation, and a multidisciplinary approach will minimize these risks. There are no methods of anaesthesia that are preferable to others during pregnancy. The most important preventive measure is to maintain maternal haemodynamic stability and normoventilation in order to ensure fetal well-being. Extensive knowledge of the profound anatomical and physiological changes that a pregnancy induces is mandatory for the team when operating on a pregnant woman. Short time exposure to anaesthetic agents in clinically relevant doses during surgery has never been demonstrated to have teratogenic effects. Lately, focus has been made on the possible behavioural teratogenic properties of anaesthesia, especially on the use of NMDA receptor antagonists and GABA receptor agonists. Emergency diagnostic imaging during pregnancy is considered safe and should be performed if necessary. Electroconvulsive therapy for the treatment of serious psychiatric disorders during pregnancy is a possibility that should be considered if necessary. Electric cardioversion seems safe for the fetus if life-threatening arrhythmias occur during pregnancy. Trauma is one of the leading non-obstetric causes of maternal mortality and morbidity. When treating a traumatized pregnant woman one should initially focus on the mother’s safety and haemodynamic stability.