Blog
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Aug 03 2017
5 Scary ECG Patterns Not to Miss from Mattu and Brady
Learn the ECG patterns for posterior MI, left main disease, the ominous isolated T-wave inversion in aVL, large upright T-wave in V1, and Wellen's warning. This full text article is mandatory reading.
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Aug 02 2017
Mostly Dead Is Slightly Alive – H&P in Chest Pain
History and exam features are not useless in the evaluation of patients with chest pain, but they must be used as part of a risk stratification strategy that includes ECG and troponin.
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Aug 01 2017
What Lurks in Infant CSF These Days?
E. coli and GBS were the most common pathogens causing meningitis in infants under 90 days in this cohort. Add ampicillin for the first month to cover Listeria. If gram-negative meningitis is present, consider changing to a carbapenem (like meropenem).
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Jul 31 2017
MRI Misses Stroke
False negative DWI MRI imaging happened in about 7% of cases. If you strongly suspect ischemic stroke clinically, especially posterior stroke, press to admit for further workup.
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Jul 29 2017
Why We Use the PERC Rule
The PERC rule is a powerful diagnostic tool. If you determine a patient has low clinical gestalt for PE and all 8 PERC criteria are negative, then PE has been ruled out without checking a D-dimer or CT.
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Jul 28 2017
How A 5-Sentence NEJM Letter Caused the Opioid Epidemic
A 5 sentence letter to the NEJM editor in 1980 has been cited over 600 times to support opiate prescribing, which was not even the point of the original letter. We bought the line that opiates for legitimate pain were not addictive and didn't consider the source.
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Jul 27 2017
Angioedema – Icatibant Rant
Icatibant did not improve outcome compared to placebo for ACE-I associated angioedema.
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Jul 26 2017
Nebulized Hot Salts – What Could Possibly Go Wrong?
Hypertonic saline nebulized treatments did not reduce hospitalization in children with bronchiolitis in this large RCT.
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Jul 25 2017
Antibiotics as Weapons of Mass Destruction
Adverse effects from antibiotics are very common, up to 20% of the time in hospitalized patients. Only use them when needed.
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Jul 24 2017
FAST Exam Useless in Stable Kids
FAST exam didn't have an impact on the care of stable children with torso trauma.