Dessert

here are some more tidbits (this time with citations). I'll be going back and adding citations to the prior studies....

• Schwartz, D., Israeli Med Assoc J 7:502, August 2005: routine use of PT/PTT is not required in the general evaluation of ACS. The results don't typically alter the outcome or management. The only time it'd matter is if you're going to start someone on heparin and that still was only seen in one patient affecting management. It'd save $, however I don't realistically see us changing our CP protocol unless there's a good consensus about it
• Sabatine, M.S., et al, JAMA 294(10):1224, September 14, 2005 : If somebody is going to get PCI due to STEMI, it's better to load these patients with Plavix 300 mg PO then 75 mg PO q day.
• On an aside note while it's in my brain, remember to type q day or q 24 hours vs qd (this is from pharmacy). Also avoid MSO4, MS, etc (use morphine)
• Novo-7 will be approved by P&T and will be soon available from the pharmacy. Become familiar with this for treatment in intracerebral bleeds
• Fonarow, G.C., et al, Am J Card 96(5):611, September 1, 2005: Some suggestions that there's a benefit to early statins administration in AMI with a decrease in significant bad outcomes. There needs to be a randomized control trial to support these claims. Expect to hear more about this from the cardiologists as it was a focus of their meetings in New Orleans this year.
• Morrison, L.J., et al, Resuscitation 66:149, August 2005: Biphasic defibrillation was better than monophasic defibrillation in converting to an organized waveform, but no change in spontaneous circulation, survival, etc. It may help you get a prettier rhythm but no change in survival.
• Milling, T.J., et al, Crit Care Med 33(8):1764, August 2005: A significant decrease in cannulating central lines with U/S guidance. This has been seen in several other studies. Bottom line is once we get a portable U/S machine-SonoSite (ahem Evan) we'll be able to significantly improve our TLC placement. I would highly recommend that one of our first inservices with these machines would be on central line placement. Something to keep in mind as well for aggressive early goal-directed therapy for sepsis and perhaps replacing dislodged HD catheters.
• Anderson, B.A., et al, Am J Surg 190(3):474, September 2005: PLEASE NOTE AND FORWARD TO RADIOLOGY- to rule out appendicitis, a CT Abd/pelvis does NOT require PO contrast. The only problem is they used rectal contrast (I think I'd take the oral). But still this would significantly decrease our time to CT scan for appy evaluation.
• Rady, M.Y., et al, Arch Surg 140:661, July 2005: No difference in ICU patients on vasopressors when treated with corticosteroids, even if they had a high or low cortisol and/or responding to or not to ACTH.
• Abraham, E., et al, New Engl J Med 353(13):1332, September 29, 2005: Xigris (very expensive drug) didn't improve outcome/mortality for patients with severe sepsis and caused significant bleeding. May actually do more harm, costs a lot and hasn't proven benefit. Bottom line- I won't be asking the intensivists if we should start Xigris.
• Signs/symptoms of botulism are a floppy baby with constipation, ptosis, poor sucking, poor feeding and bulbar weakness. Classically starts with weakness from cephalad to caudad.
• Parlak, I., et al, Emerg Med J 22:621, September 2005: IV metoclopramide given as a slow infusion for treatment of cephalgia with or without nausea/vomiting produced the same results with significantly decreased rates of akathisia when given as a bolus (25% vs 5%). Bottom line- consider it in headache patients but give it as a slow infusion to decrease side effects.
• Still no studies demonstrating a significant clinical difference between levalbuterol (Xopenex) and albuterol.
• DiRusso, S.M., et al, J Trauma 59:84, July 2005: Takes a strong stance that field prehospital pediatric intubation does not show ANY benfit and in fact may produce a negative outcome. It's better to scoop, bag and run.
• That's it for this session. Hope these helped...