In 2001, the Rivers trial showed that Early Goal Directed Therapy for septic shock resulted in a 16% absolute mortality risk reduction1. In the treatment arm of this trial, septic patients with a lactate above 4 mmol/L or systolic blood…
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A new randomized controlled trial refutes the theory that either Epogen or liberal transfusions will improve neurologic outcome in patients with traumatic brain injury. Head trauma occurs in 1.5 million Americans annually, at a cost of more than $56 billion. Erythropoietin…
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Results of the Syntax trial suggests that PCI and CABG have comparable results for most patients with left main disease. The results suggest that the all-cause mortality was lower with PCI vs CABG in patients with Syntax scores <=32, but…
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There has always been some controversy about the utility of applying cricoid pressure (aka Sellick Maneuver) during rapid sequence intubation for the purpose of preventing aspiration.  Theoretically, applying pressure on the cricoid cartilage posteriorly should occlude the esophagus against the…
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Outpatient treatment of acute DVT is as safe as inpatient treatment in patient’s with an adequate home situation. Cohort study of 13,500 patients diagnosed with an acute lower extremity DVT and treated with either low molecular weight heparin or fondaparinux.…
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Direct vs Video Laryngoscopy In 1878 William MacEwan first passed a tube into the trachea of an awake patient using his fingers as a guide.  Now health care providers routinely perform endotracheal intubation as a life saving intervention.  Despite over…
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Preface: Patients with COPD exacerbations requiring ICU admission did better with low-dose steroids vs high-dose steroids Cohort study of 17,239 patients with COPD exacerbations admitted to the ICU * ​1/3 required noninvasive ventilation * 15% were intubated * Virtually all…
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The USPSTF continues to recommend screening primarily in 65- to 75-year-old men who have ever smoked. U.S. Preventive Services Task Force (USPSTF)​ Background Prevalence of abdominal aortic aneurysms (AAAs; defined by an aortic diameter of ≥3.0 cm) in adults older…
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Frequently the combination of a serum D-dimer level and compression ultrasound testing can differentiate between a residual venous clot and an acute recurrent DVT.  However, sometimes the results are equivocal and in these situations an MRI direct thrombus imaging can…
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Patients with minimal free fluid and no abdominal tenderness can be observed, while patients with moderate-large amounts of free fluid and abdominal tenderness should undergo operative exploration. To determine if operative exploration or observation is the preferred management for hemodynamically…
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Two systematic reviews and meta-analyses have demonstrated no long-term benefit for back pain, leg pain, or disability using epidural steroid injections for either sciatica or lumbar spinal stenosis. The first systematic review and meta-analysis in 2012 analyzed 23 trials of…
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