Brit J Hosp Med
-
Pulmonary embolism is a potentially fatal consequence of venous thromboembolism and constitutes a significant proportion of the acute medical take. Standard management has previously required admission of all patients presenting with acute pulmonary embolism for initiation of anticoagulation and initial investigations. However, clinical trial data have demonstrated the feasibility and safety of managing a subset of patients with low-risk pulmonary embolism in the outpatient setting and this has since been reflected in national guidelines. This article provides a practical overview for general physicians with regards to identifying patients with low-risk pulmonary embolism, and when and how to manage these patients on an outpatient basis.
-
This article summarises the clinical decision tools available to help decide when acute lower limb joint injuries should be referred for plain film radiography. The Ottawa foot and ankle rules are a tool for deciding whether to refer a patient for X-ray or not. ⋯ Although the Pittsburgh rules are more specific, they have been less extensively investigated and, unlike the Ottawa rules, are not National Institute for Health and Care Excellence recommended. A major barrier to use of these rules in clinical practice is the concern of litigation, although National Institute for Health and Care Excellence recommendation should reassure clinicians and thus reduce the amount of unnecessary radiation exposure.
-
Peripheral artery disease of the lower limbs is a chronically progressive disorder characterised by the presence of occlusive lesions in the medium and large arteries that result in symptoms secondary to insufficient blood flow to the lower extremities. It is both a manifestation of systemic atherosclerosis and a marker of increased cardiovascular morbidity and mortality. Because of its highly heterogenous clinical picture, a detailed history and physical assessment, a high degree of suspicion for peripheral artery disease and the use of the ankle-brachial pressure index is essential to identify patients with peripheral artery disease. This will allow early administration of basic pharmacotherapy and lifestyle changes to reduce cardiovascular events, minimise claudication symptoms and enable optimal revascularisation to prevent loss of limb function.