Doctors of golden hour

24/11/2022

Blue zones_where people are speculated to live longer than average.

16/11/2022

coagulation panel myths
#1: Coagulation testing is necessary in the evaluation of all chest pain.

#2: Coagulation testing is necessary for perioperative or pre-procedure assessment.

#3: Coagulation testing is necessary in patients being admitted as screening for coagulopathy.

Literature suggests that coagulation panels obtained on these patients does not change management.

Coagulation testing should not be used for screening purposes in admitted patients, especially with the infrequency of bleeding disorders in asymptomatic patients.

For those on antiplatelets and not anticoagulants, a coagulation panel is not helpful.

Indications for a coagulation panel:

1. Evident bleeding
2. h/o unexplained bleeding
3. Liver disease, sepsis, cerebrovascular accident, DIC, preeclampsia/HELLP, cholestasis, poor nutrition
4.about to receive thrombolytics, or those taking anticoagulants.

15/10/2022

26/08/2022

Tomato flu outbreak in India
Vivek P Chavda
Kaushika Patel
Vasso Apostolopoulos Published:August 17, 2022DOI:https://doi.org/10.1016/S2213-2600(22)00300-9

18/08/2022

Due to the high volume of distribution, tigecycline achieves poor serum concentrations (approximately 0.6 mg/L). For this reason, tigecycline should not be used for endovascular infections, such as bacteremia or endocarditis.

13/08/2022

KURU, a deadly disease of fore people of new guinea, once very prevelant, nearly disappeared after people stopped consuming brains of there dead relatives (ritualistic cannibalism)
Prions are the only known transmissible pathogens that are devoid of nucleic acid

01/08/2022

In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo.

16/07/2022

Clinical Probability Adjusted D-Dimer: The PEGeD Study NEJM 2019

Prospective study, 2017 patients presenting to the ED with symptoms of pulmonary embolism

7-item Wells clinical prediction rule used to delineate low (0-4), moderate (4.5-6) or high (>6.5) risk of pulmonary embolism

Low risk group (n=1,752): discharged without CTPA if d-dimer below 1,000 ng/ml FEU

Moderate risk group (n=218): discharged without CTPA if d-dimer below 500 ng/ml FEU

High risk group (n=47): sent directly for CTPA
Zero patients discharged without CTPA based on adjusted d-dimer cutoffs had a pulmonary embolism at 3 months

17.6% reduction in CTPA use with adjusted d-dimer cutoffs compared to a universal cutoff of 500 ng/ml FEU

CONCLUSION_ consider using clinical probability adjusted d-dimer cut offs if your ED has a typically low risk population