ALiEM - 52 in 52
I'm excited to announce a new collaboration with Academic Life in Emergency Medicine. They published an updated version of the 52 in 52 post. These are 52 landmark articles that each resident (and those of us in practice) should know. They were critically assessed and chosen by residency leaders from around the country. But if you visit the post, you'll see it's just a list of references.
The Spoon-Feed Advantage
It's tough to find the time to sit down and read them all. Yet these key papers shape the way we practice emergency medicine every day. So open wide for some weekend wonders throughout 2017.
EM Topics will do what we do best and Spoon Feed these to you every Saturday during 2017. Taking them one at a time for a year, you will be able to engage with each article. Hopefully, the taste from EM Topics will pique your curiosity to go deeper and dig into these critical papers. Each summary will have links to go as deep as you want to go.
Enjoy! And tell a friend what they're missing.
HELP SPREAD THE MISSION:
BETTER PATIENT CARE THROUGH SPOON FEEDING
Bonus Short Attention Span Summary
Elderly with headache
Thanks to Thomas Davis, one of our EM 3rd year residents, for pointing this article out to me. It is a great review article about giant cell arteritis. Here are some key points.
- It presents in elderly patients with headache, scalp tenderness, vision symptoms, jaw claudication, and often with polymyalgia rheumatica.
- There is frequently a prodrome of fever, malaise, anorexia, and weight loss.
- Inflammatory markers are usually elevated, but the ESR/CRP are normal in ~10% of patients with proven GCA.
- Apart from blindness, the feared complications are aortic aneurysm rupture or dissection.
- Diagnosis relies on usual symptoms, inflammatory markers, and temporal artery biopsy.
- Treatment is steroids in addition to low-dose aspirin, which I did not know. "Corticosteroid therapy initiated at least 15 days before biopsy does not seem to diminish positive findings. Given the increased risk for vision loss in GCA, corticosteroid therapy should not be withheld pending biopsy."
- Temporal artery biopsies are frequently negative: "Given that results on temporal artery biopsy are positive in 49%–85% of patients with unequivocal GCA, negative results may be misleading and discourage less-experienced practitioners to treat a patient with convincing clinical evidence of GCA."
Quoted from the article: "The diagnosis of GCA should be considered in patients older than 50 years who present with new-onset, localized, unilateral headache; ischemic symptoms in the cervicocranial and upper vascular territories (e.g., jaw claudication, vision aberration or loss); and muscle stiffness of the neck, shoulder, or pelvic girdle. Typical physical examination findings include tenderness, swelling, and erythema over the temporal artery and flow abnormalities of large vessels (e.g., bruits, asymmetrical pulse or blood pressure). Most patients have markedly elevated ESR or CRP. GCA involvement of large vessels is common and subclinical in most patients. Temporal artery biopsy is considered the gold standard for diagnosis."
Treatment is with high dose prednisone, which should be started ASAP, even if prior to temporal artery biopsy.
Ann Intern Med. 2016 Nov 1;165(9):ITC65-ITC80. doi: 10.7326/AITC201611010.
This issue provides a clinical overview of giant cell arteritis, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.
PMID: 27802475 [PubMed - in process]