One of the more common presenting complaints to an ED is the adult presenting with chest pain. In addition, one of the most common reasons for admission to a hospitalist service is the “Chest pain rule out MI” admitting diagnosis.…
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Where to place a central venous catheter is a decision driven mainly by individual preference. The limited evidence available has not established any site as superior; the subclavian position has been reported as being less infection-prone, but more likely to cause…
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Fever is universally treated in the setting of infection in virtually all hospitals, but does treatment of fever improve outcomes in patients with sepsis? This meta-analysis of eight randomized trials (1507 patients) and six observational studies (2058 patients) that compared…
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An elevated peripheral neutrophil-lymphocyte ratio is an indicator of inflammation. Investigators from a Turkish university hospital hypothesized that this ratio might differ in patients with subarachnoid hemorrhage (SAH) versus those with other headache syndromes. They performed a retrospective study of…
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More Articles – Cardiovascular diseases, Emergency Procedures, Medical General, Oncology, Respiratory diseases, Traumatology
Key Recommendations 1). Initial evaluation Conduct physical exam, history (with careful attention to factors in Tables 1 & 2) and resting electrocardiogram (ECG) to identify a possible cause (see Tables 2 & 3). 2). Disposition from the emergency department (ED)…
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More Articles – Cardiovascular diseases, Central line, Medical General, medical procedures, Neurological diseases
Prior studies have found that in patients with cryptogenic ischemic strokes, extended post-stroke cardiac monitoring detects intermittent atrial fibrillation (AF) in up to 20% of cases. Now, an industry-sponsored study from Germany randomized 400 patients all over 60 years old…
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Prior studies have suggested that patients should be intubated emergently in an upright, head-forward position rather than in the traditional supine position. This is especially true for intubations of morbidly obese patients where it is known that pre-oxygenation and intubation in…
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The Infectious Diseases Society of America (IDSA) guidelines remain the gold standard guidelines for infectious disease problems. The IDSA recommends treating patients with community-acquired pneumonia (CAP) for 5 days and it recommends treating those with healthcare-associated pneumonia (HCAP) for 7-8…
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The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics. Time-dependent antibiotics have increased bactericidal activity the…
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Although pulmonary embolism (PE) occasionally presents with syncope, patients with syncope are infrequently assessed for PE. This prospective study from Italy studied 560 elderly adults (mean age, 76) who were hospitalized for syncope. Those excluded from the study included patients…
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There are multiple noninfectious medical disorders that mimic cellulits. In this retrospective study, researchers focused on misdiagnosis of cellulitis in 259 patients hospitalized with presumed diagnoses of lower extremity cellulitis at a Boston teaching hospital. Patients with complicating factors (e.g.,…
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More Articles – Cardiovascular diseases, Emergency Procedures, Hematology, Medical General, medical procedures
The Universal Termination of Resuscitation Guidelines suggest that resuscitation should be terminated if at least four rounds of CPR have occurred and the following three criteria are met: The arrest was NOT witnessed by emergency medical services (EMS) There has…
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The 2015 American Heart Association Advanced Cardiovascular Life Support guidelines deemphasizes advanced airway placement during the initial resuscitation. Out-of-hospital–arrest data suggest lower survival among patients who are intubated in the field. Therefore, it is important to determine the importance of…
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The shock index — the ratio of heart rate to systolic blood pressure — is a new measure that may predict a poor outcome. Most of the studies using the shock index have been in trauma patients and those with…
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Definitions Presumed source with SIRS criteria = infection Infection with life-threatening organ dysfunction = sepsis Sepsis refractory to intravenous fluid challenge = septic shock Treatment of sepsis or septic shock Draw blood cultures x 2 Analyze any fluid that may…
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