Diagnosis and Treatment Options for Pulmonary Embolism (PE) in the Acute Care Setting

Thromboembolic diseases continue to be one of the most prevalent medical problems today and can lead to life-threatening conditions, such as pulmonary embolism (PE). Currently, PE diagnosis and treatment are a challenge because of acute onset right ventricular strain with right-sided heart failure, sudden death, pulmonary infarction, and cardiogenic shock, which limit the time for therapeutic success.?The aim of this study was to evaluate our perception, knowledge, and concerns regarding PE, discuss the importance of promptly diagnosing PE to provide appropriate treatment options for this life-threatening condition, list the most common clinical manifestations present when PE is suspected, and review the clinical approach to patients with suspected PE in an inpatient setting.?In addition, this study reviews the risk stratification of patients with PE and treatment options beyond anticoagulation, compares new treatment options for patients presenting with acute symptomatic PE, and compares aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter (Vascular Solutions, Minneapolis, MN)) and ultrasound-assisted catheter-directed thrombolysis (USAT) versus systemic thrombolysis.This literature review was limited by the quality and number of studies available regarding new treatment options for patients presenting with acute symptomatic PE. Thus, more studies are needed to prove the validity of newer treatment options being trialed, such as aspiration catheters (10 F Pronto .035” and 14 F XL extraction catheter) and USAT, with the hope that further studies will guide patient management and increase our understanding of next generation aspiration catheters, which may provide novel insights on treating acute symptomatic PE.

Water Resources, Infrastructure Restoration, and Protection of the Upper Mississippi River Basin

The Upper Mississippi River flows approximately 2000 km from Lake Itasca, Minnesota to Cairo, Illinois where it is confluences with the Ohio River to form the Lower Mississippi River. North of the confluence, numerous snags, sand bars, rapids, and other obstructions made the Upper Mississippi River travel difficult. This paper highlights how the geological and landscape resources of the Upper Mississippi River and tributary watershed were responsible for the successful economic development of this historically rich region of North America. Environmental challenges include an attempt to keep invasive species such as the Asian carp out of the rivers and lakes north of the Twin Cities. In an attempt to protect the Mississippi River resource, Environmental and Conservation groups have opposed continued navigation through Minneapolis and St. Paul and the planned Upper Mississippi River navigation infrastructure restoration by the United States Corps of Engineers including the upper and lower St. Anthony locks and dams. These Environmental, Conservation and Save the River groups are attempting to mitigate the historic highest and best use of the Mississippi River and adjacent watershed, navigation, and economic development, by having the urban river restored to the natural state.