Lauren Westafer, DO MPH MS

EM doc @BaystateEM |@FOAMpodcast co-founder #FOAMed |#impsci & #VTE researcher| addiction Med | 🏳️‍🌈she/her #LGBTQinMedicine

[The PERT Consortium® @PERTConsortium]

Is high pre-test probability for PE a slam dunk? Are there nuances in diagnosing PE in this population? @LWestafer explains at #PERT2025 @PERTConsortium

[Anton Helman @EMCases]

EM Cases' High Risk PE Management Algorithm
Created by Sara Brade based on latest podcast with @LWestafer @AnotherICUdoc @First10EM
https://t.co/kCgxklyvBl
#FOAMed #emergencymedicine

[Anton Helman @EMCases]

How do you predict which intermediate-risk PE patients will suddenly deteriorate? What role do risk scores/biomarkers/imaging play? Indications for lytics? Cath interventions? @AnotherICUdoc @LWestafer @Fist10EM.
Risk Stratification & Management:
https://t.co/mdMsjTADJJ
#FOAMed

[FOAMcast @FOAMpodcast]

FOAMcast is baaaaaack. A major thought on asthma....we can and should do better for the patients we discharge from the ED

[Ken Milne MD @TheSGEM]

How would you rule out a pulmonary embolism in a high-risk patient (Well's >6)?
https://t.co/Aq2JTFGvvC @LWestafer @SAEMonline

Vote & then check out #SGEMHOP in @AcademicEmerMed
https://t.co/LKqdBTa62v

[Lauren Westafer, DO MPH MS @LWestafer]

@reverendofdoubt Correction: There is a cap gap but your institution won’t invest in it

[Lauren Westafer, DO MPH MS @LWestafer]

@reverendofdoubt @pulmtoilet @drjgutt @EMHighAK @TheShenger @SkylerLentz @sreeja_natesan @MikePallaci @davidcarr333 @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak @skobner @AaronLacyMD @MRamzyDO Do you have EM buy in/representation? Our PERT actually often says, no intervention but pretty please switch to LMWH (but then Again I’m on nearly all calls 🙃 and our crit care chief and IR folks are all in on it)

[Lauren Westafer, DO MPH MS @LWestafer]

@drjgutt @itraslan @reverendofdoubt @EMHighAK @TheShenger @SkylerLentz @sreeja_natesan @MikePallaci @davidcarr333 @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak @skobner @AaronLacyMD @MRamzyDO @pulmtoilet Maybe, but there’s strong therapeutic momentum within the hospital spectrum that makes switching to a better anticoagulant more of a hassle, it’s our job in EM to order the best drug for the patient up front (which is sometimes but rarely UFH) https://t.co/ZOUggTVDJb

[Lauren Westafer, DO MPH MS @LWestafer]

@pulmtoilet @EMHighAK @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MikePallaci @davidcarr333 @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak @skobner @AaronLacyMD @MRamzyDO @reverendofdoubt Yes! I helped create it and help facilitate it

[Lauren Westafer, DO MPH MS @LWestafer]

@EMHighAK @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MikePallaci @davidcarr333 @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak @skobner @AaronLacyMD @MRamzyDO @reverendofdoubt @pulmtoilet An abbreviation …for ____ sake

[Lauren Westafer, DO MPH MS @LWestafer]

@pulmtoilet @EMHighAK @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MikePallaci @davidcarr333 @PulmCrit @EMinMiami @Dane_o_MD @rob_cosentini @petrosoniak @skobner @AaronLacyMD @MRamzyDO @reverendofdoubt No. I love POCUS for alternative diagnosis (see new onset HF often cause of symptomsand PE incidental) and TAPSE. Most patients don’t need intervention stat. There are so many ways to triangulate and confirm rv dysfunction of peri shock states.

[CJEM @CJEMonline]

Do clinical decision rules actually help with diagnosis in medicine?
The latest #CJEMDebate explores the question with @First10EM @emlitofnote @LWestafer @reverendofdoubt and @PaulAtkinsonEM

➡️Read https://t.co/BNdE1Wu70H then

⬇️Vote on the debate here:

[Lauren Westafer, DO MPH MS @LWestafer]

Question for radiologists (and others)...on CTPAs, if/when you use the term "filling defect" but don't specifically qualify PE yes or PE no, what does this mean/what is your certainty(%) that it is a PE?

[Lauren Westafer, DO MPH MS @LWestafer]

@JakeHoyne @reverendofdoubt I find insurance coverage pretty good for many (seems like insurance companies have learned it saves $$ overall) but it takes time to figure out what is on formulary for each specific patient.

[Lauren Westafer, DO MPH MS @LWestafer]

You routinely ensuring your patients in the ED with asthma exacerbations have an ICS? It's time we get on board https://t.co/yByJ1aDHEM

[Lauren Westafer, DO MPH MS @LWestafer]

@DrJayMohan On the other hand - this opens up the role for a potentially easy intervention: leveraging our consultants who actually perform CDT to champion specific anticoagulant guidance

[Lauren Westafer, DO MPH MS @LWestafer]

We recently published a study of nearly 300,000 patients hospitalized with acute PE and found a surprising rise in UFH use, discordant with guidelines. As a follow-up, we just published a qualitative study to find out....WHY? The results were interesting 🧵

[Lauren Westafer, DO MPH MS @LWestafer]

@DrJayMohan Exactly! But practicing docs *believe* , for whatever reason that AC is turned off/reversed for CDT. At PERT conference we asked who would be uncomfortable using LMWH and 0 were uncomfortable. It’s amazing how this anticipation of “what IR/IC wants” is NOT grounded in data/fact

[Lauren Westafer, DO MPH MS @LWestafer]

Looking forward to tackling what may be perceived as esoteric to improve the quality and value of care for patients with PE! (7/)

[Lauren Westafer, DO MPH MS @LWestafer]

Interestingly, the notion that anticoagulation is *reversed* and *withheld* for catheter directed treatment was not only nearly ubiquitous but also a powerful determinant of UFH use (guidelines rec continuation of anticoagulation during advanced therapies) (6/)