Search

Introduction: The recommendation to discharge low-risk pulmonary embolism patients from or after a brief monitoring in the emergency department has not been widely adopted in Finland., Methods: We explored the practices for examination and treatment of patients with pulmonary embolism in a university hospital and a central hospital. An assessment was made on how these practices followed the risk classifications., Results: A very small proportion (3.9%) of the patients were discharged directly from the emergency department. According to the risk classifications, the proportion of patients suited for home care would have been between 30 and 60%., Conclusions: A significant proportion of patients with pulmonary embolism can be treated on the outpatient basis.

Most of the patients with pulmonary embolism have in Finland been treated in inpatient wards, there is much to be learned about the identification of patients with low risk of death. The assessment is based on clinical factors. Circulation should furthermore be stable without any signs of increased workload of the right side of the heart. Appropriate patient education and case-specific follow-up must be taken care of. Direct oral anticoagulants are a good alternative to low molecular weight heparin and warfarin therapy.

Emergency Medicine (EM) was established as a speciality in Finland in the beginning of 2013. The training period of six years conforms to the principles of the European Curriculum for EM. We present here the first-year training in Kanta-Häme Central Hospital, located in Southern Finland. Training is not only based on "learning by doing". Lunchtime lectures covering a wide variety of topics in EM are an essential part of our weekly education day. This day also offers to the residents small group sessions with abstracts, case reports, focused lectures and ultrasound training. A successful training program of EM is achievable by good collaboration with other specialities.

The determination of troponin from a blood sample is the most sensitive means to prove a recent myocardial injury. An elevating troponin level associated with acute coronary syndrome indicates an increased risk of death and reinfarction, serving as an indication for an invasive investigation of coronary anatomy. Troponin is also frequently elevated in injuries not caused by cardiac infarction. The use of troponin should be focused on situations involving a suspicion of myocardial ischemia on clinical grounds. We analyzed the causes of an elevated troponin level from the emergency discharge diagnoses of 301 patients referred to internal medicine emergency.