Family Practice Notebook Updates

Aka: Family Practice Notebook Updates, FPN Updates, Family Practice Notebook Updates 2021, FPN Updates 2021

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II. Updates: September 2021

  1. College Student Medical Care (prevent, hme)
    1. Updated
  2. Burn Injury (er, environ)
    1. Updates to Burn Injury and Burn Management
    2. Additional focus on pediatric burns
  3. Neck Vascular Injury in Blunt Force Trauma (er, ent)
    1. Updates and reorganization of topic
  4. Breast Cancer Management (gyn, hemeonc)
    1. Extensive updates including to Breast Cancer Staging
  5. Hydrofluoric Acid Toxicity (er, toxin)
    1. Added with overall evaluation and management
  6. Pyloric Stenosis (surgery, gi)
    1. Updates
  7. Diagnostic Peritoneal Lavage
    1. Added infraumbilical technique
  8. Human Papillomavirus (id, virus)
    1. Updates
  9. Dysmenorrhea (gyn, sx, Menses)
    1. Updates
  10. Laryngotracheal Trauma (ent, Larynx)
    1. Updates including presentation, grading Laryngeal Fractures and management
  11. Colorectal Cancer Screening (gi, prevent)
    1. Universal Colon Cancer screening is now recommended to start at age 45 years
    2. Of diagnosed Colon Cancers, 10% are diagnosed at age 50 years
  12. Dementia Management (neuro, cognitive)
    1. Aducanumab is FDA approved for Dementia despite lack of evidence for significant efficacy
  13. Migraine Prophlaxis (neuro, Headache)
    1. Rimegepant, an Oral CGRP Inhibitor, is now approved for Migraine Prophylaxis (but is $1800/month at every other day dosing)
  14. Systolic Dysfunction (cv, chf)
    1. Added Prevention of Diuretic-Induced Hypokalemia
    2. Added Hyperkalemia Prevention
  15. Wegovy (endo, pharm)
    1. Semaglutide marketed for Obesity
  16. Primary HIV Infection (hiv, exam)
    1. Updates regarding general management including Immunizations
  17. Methotrexate (rheum, pharm)
    1. Updated with additional strategies for better tolerance
    2. Still, in 2021, Methotrexate preferred first line agent for Rheumatoid Arthritis Remittive Agents
  18. Cyclobenzaprine (rheum, pharm)
    1. Updates
  19. Sinus Node Dysfunction (cv, ekg)
    1. Updates
  20. Pertussis (lung, Bacteria)
    1. Updates
  21. Cymbalta (psych, pharm)
    1. Updates
  22. Carisoprodol Poisoning (rheum, pharm)
    1. Added toxicity as well as Carisoprodol
  23. Fingertip Amputation (surgery, derm)
    1. Added Tissue Adhesive technique for bleeding Fingertip Amputations
  24. Gastrostomy Button (gi, procedure)
    1. Updates
  25. Angioedema (ent, derm)
    1. Updates
  26. Hydrogen Sulfide Poisoning (er, toxin)
    1. Added
  27. C1 Esterase Inhibitor (ent, pharm)
    1. Updated
  28. Body Stuffer and Body Packer (er, toxin)
    1. Added approach to symptomatic and asymptomatic patients
  29. Heat Stroke (er, environ)
    1. Updates including pearls such as filling a body bag with water and ice
  30. Covid19 (lung, id)
    1. Casirivimab and Imdevimab (Regen-COV) is now approved for Post-exposure Prophylaxis in high risk patients >12 years old
  31. Vaginitis (gyn, id)
    1. Two expensive preparations available when there are much cheaper generics that work well
    2. Brexafemme (Ibrexafungerp) is now indicated for Yeast Vaginitis
    3. Secnidazole (Solosec) is now indicated for Trichomonal Vaginitis
  32. Statins (cv, pharm)
    1. In 2021, FDA allows for Statin use in high risk cardiovascular risks in pregnancy
    2. May consider use in prior MI, CVA or Homozygous familial Hypercholesterolemia
  33. Semglee (endo, pharm)
    1. Insulin Glargine-yfgn U-100
    2. Considered interchangeable biosimilar to Lantus as of 2021 in U.S.
    3. Allows pharmacists to auto-substitute Semglee (one third Lantus cost) for Lantus
  34. Perfusion Index (lung, lab)
    1. Interpreted from Pulse Oximeter waveform
    2. Reflects the strength of the pulse arriving at the detector
    3. Perfusion Index is the ratio of pulsatile to nonpulsatile blood
    4. Unlike oximetry which detects Oxygen Saturation, Perfusion Index reflects Blood Flow
  35. Fasting in Diabetes Mellitus (endo, surgery)
    1. Updated medication management in the perioperative and Fasting period
  36. Supraventricular Tachycardia Management in Pregnancy (cv, ekg)
    1. Added pregnancy related sections in Supraventricular Tachycardia Management and Ventricular Tachycardia Management
  37. Central Retinal Artery Occlusion (eye, cv)
    1. Updates
  38. Resistant Hypertension (cv, htn)
    1. Updates
  39. Hydrocarbon Ingestion (er, toxin)
    1. Extensive Updates
  40. Heavy Metal Poisoning (er, toxin)
    1. Added
  41. Decontamination (er, pharm)
    1. Updates
  42. Diabetic Foot Infection (derm, endo)
    1. Updates
  43. ADHD Medication (peds, psych)
    1. Viloxazine (Qelbree) released in 2021 in U.S. as once daily agent at $300/month (3x the cost of generic Atomoxetine)
    2. Dexmethylphenidate/SerDexmethylphenidate (Azstarys) released in 2021 in U.S. for age >6 years old at $390/month ( 8x the cost of similar generics)

III. Updates: August 2021

  1. Complex Regional Pain Syndrome (rheum, neuro)
    1. Reviewed CRPS
  2. Distal Humerus Fracture (ortho, elbow)
    1. Added evaluation, classification and management of Distal Humerus Fractures
  3. Eating Disorder (psych, eating)
    1. Updates
  4. Refeeding Syndrome (psych, eating)
    1. Added
  5. Insulin Pump (endo, pharm)
    1. Updated
  6. Upper Extremity DVT (hemeonc, cv)
    1. Updated
  7. Catatonia (neuro, psych)
    1. Added
  8. Euglycemic Ketoacidosis (endo, dm)
    1. Updates
  9. Amnesic Shellfish Poisoning (er, neuro)
    1. Another Neurotoxin in shellfish
  10. Whole Bowel Irrigation (er, pharm, toxin)
    1. Updated procedure and related measures
  11. Nextstellis (gyn, pharm)
    1. New expensive OCP with a specific Phytoestrogen combined with drosperidol
  12. Nimodipine (cv, pharm)
    1. Added this oral Dihydropyridine Calcium Channel Blocker used following Subarachnoid Hemorrhage
  13. Auricular Hematoma (ent, ear)
    1. Updates to drainage technique
  14. Tachycardia (cv, ekg)
    1. Findings that differentiate SVT with aberrancy from VT
  15. Jet Lag (id, travel)
    1. General measures reviewed
  16. Stings (er, derm)
    1. Reviewed Jellyfish and Scorpion Stings
  17. Actinic Keratosis (derm, hemeonc)
    1. Reviewed management including another new expensive option (Klisyri)
  18. Diabetic Foot Care (endo, prevent)
    1. Prevention reviewed
  19. Tall R Wave in Lead V1 (cv, exam)
    1. Reviewed causes
  20. CT Abdomen and Pelvis (surgery, rad)
    1. Reviewed low attenuation contrasts (air, water) benefits
  21. Lymphatic System (hemeonc, anatomy)
    1. Reviewed lymphatic background information
  22. Immune System (id, immune)
    1. Background physiology review
  23. Benzonatate Overdose (lung, pharm)
    1. Narrow therapeutic range, potentially lethal with a single capsule in children, or a handful in adults
  24. Hypersensitivity Reaction (ent, allergy)
    1. Updated Hypersensitivity Reaction types and examples
  25. Cyclodialysis Cleft (eye, Trauma)
    1. Complication from Blunt Eye Trauma with risk of Ocular Hypotony and its complications
  26. Unintentional Weight Loss (endo, geri)
    1. Updated based on re-review
  27. Costochondritis (cv, sx)
    1. Updated Costochondritis, and Chest Wall Pain causes
  28. Newborn HIV Prophylaxis (hiv, peds)
    1. Updates to prevention of HIV vertical transmission, as well as management of HIV in Pregnancy
  29. Hernia Reduction (surgery, gi)
    1. Updated Hernia Reduction
  30. Diverticulitis (gi, id)
    1. General updates
  31. Biotin (pharm, Vitamin)
    1. Updates related to excessive Biotin in supplements and the related lab testing interactions
  32. Diagnostic Immunology (lab, id)
    1. Added topics related to basic lab testing for Antibody and Antigen
  33. Blood Type (hemeonc, lab)
    1. Reviewed Blood Type, ABO, Rh, minor Antigens
  34. Inconsolable Infant (neuro, peds)
    1. Reviewed evaluation and management
  35. Hemorrhage (er, cv)
    1. Reviewed hard and soft arterial injury findings
  36. Cardiac Electrical Storm (cv, ekg)
    1. Recurrent Ventricular Tachycardia, Ventricular Fibrillation management
  37. Mass Casualty Incident (er, Trauma)
    1. Basic updates
  38. Ecmo (cv, procedure)
    1. ECPR study from Minneapolis shows promise in outcomes for out-of-hospital arrest and refractory V-Fib

IV. Updates: July 2021

  1. Hip Dislocation (ortho, hip)
    1. Added new complete review of Hip Dislocation and the many reduction techniques
  2. Ankle Dislocation (ortho, ankle)
    1. Added new review of Ankle Dislocation and it's reduction
  3. Knee Dislocation (ortho, knee)
    1. Updated Knee Dislocation and Patella Dislocation
  4. Pediatric DKA Treatment (endo, dm)
    1. Reviewed and alternative management protocol for mild to moderate DKA
  5. Cardiogenic Shock (cv, chf)
    1. General pearls on differentiating from other causes of shock
  6. Vagus Nerve Stimulator (neuro, surgery)
    1. Reviewed indications and disabling as well as triggering device
  7. Brief Resolved Unexplained Event (peds, er)
    1. Updates to management
  8. Adrenal Gland (endo, anatomy)
    1. Thank you to Dr. Dhafer for the correction (Medulla and cortex were reversed)
  9. Respiratory Failure (lung, failure)
    1. Extensive updates to the approach and management from a physiologic approach
  10. Endotracheal Intubation (lung, pharm)
    1. Reviewed prevention and management of post-intubation complications
  11. Topical Corticosteroid (derm, pharm)
    1. Thank you for correction by Dr. David Desai (Triamcinolone Acetonide potency)
  12. Droperidol (gi, pharm)
    1. Updates related to mechanism, precautions, adverse effects
  13. Bromethalin Poisoning (er, toxin)
    1. Rodenticide Poisoning in humans with low toxicity in general, except in intentional ingestion
  14. Atelectasis (lung, alveoli)
    1. Updates particularly to chest imaging findings
  15. Femoral Shaft Fracture (ortho, hip)
    1. Updated Femoral Shaft Fracture as it relates to Pediatric Fractures
  16. Clotting Pathway (hemeonc, exam)
    1. Clotting physiology reviewed
  17. Intravenous Regional Anesthesia or Bier Block (surgery, pharm)
    1. Described procedure, indications, contraindications
  18. Irritable Bowel Syndrome (gi, bowel)
    1. General updates
  19. Perineal Laceration Repair (ob, procedure)
    1. Updates to repair procedure
  20. Mobility Devices (sports, pharm)
    1. Reveiwed ambulatory aids
  21. Esketamine (surgery, Anesthesia)
    1. Further information regarding an atypical, intranasal Major Depression adjunct
  22. Ethylene Glycol Poisoning (er, toxin)
    1. Additional information regarding Poisonings
  23. Transient Global Amnesia (neuro, cognitive)
    1. Additional pathogenesis reviewed including venous congestion, and Hippocampus changes
  24. Postpartum Hemorrhage (ob, ld)
    1. Expanded on compressive uterine packing
  25. Emergency Fasciotomy (er, procedure)
    1. Forearm Fasciotomy technique is reviewed
  26. Valbenazine (psych, pharm)
    1. Tardive Dyskinesia agent
  27. Sulfur Dioxide Poisoning (er, toxin)
    1. Reviewed findings and management
  28. Disability (sports, Disability)
    1. Reviewed Implicit Bias Related to Disability

V. Updates: June 2021

  1. Tinnitus (ent, sx)
    1. Extensive updates to overall evaluation and management
  2. Planned Out-Of-Hospital Birth (ob, ld, natural)
    1. Added page on risks, benefits, indications, contraindications and management
  3. Left Ventricular Assist Device (cv, procedure)
    1. General approach and management updated for the LVAD patient
  4. Paraquat Poisoning (er, toxin)
    1. Herbicide ingestion kills more than 300,000 per year in Asia-Pacific region
  5. Baclofen Withdrawal (rheum, pharm)
    1. Updated Baclofen mechanism and Baclofen Withdrawal management
  6. Benzonatate (Tessalon Perles)
    1. Benzonatate (Tessalon Perles) is not as safe as you thought
  7. Allergic Acute Coronary Syndrome (Kounis Syndrome)
    1. Severe allergy or Anaphylaxis may trigger Acute Coronary Syndrome in up to 1% of cases
  8. Amnesia (neuro, cognitive)
    1. Added content related to Amnesia, Psychogenic Amnesia (Dissociative Amnesia), Transient Global Amnesia
  9. CT Head (neuro, rad)
    1. Updated CT Head with CNS blood appearance
    2. Updated Hounsfield Unit to include brain window and subdural window
  10. Meckel's Diverticulum (surgery, gi)
    1. Extensive updates on evaluation and management
  11. QRS Complex (cv, exam, ekg)
    1. Large amplitude QRS Complexes are a normal finding in young, healthy athletes (not LVH)
    2. Avoid using QRS amplitude alone to diagnose LVH in age <40-45 years old
  12. Rapid Infusion Catheter (er, procedure)
    1. Large bore catheter with flow rates >14 gauge IV, placed by seldinger technique, replacing peripheral IV
  13. Lofexidine (psych, pharm)
    1. Central Alpha Adrenergic Agonist similar to Clonidine indicated for Opioid Withdrawal symptoms
  14. Gamma Hydroxybutyrate
    1. Updated background information and management for Intoxication and withdrawal
  15. ICU Follow-up Care (prevent, hme)
    1. Overview of ambulatory follow-up for patients recovering from Critical Illness
  16. Hypothyroidism (endo, Thyroid)
    1. General updates including Myxedema Coma and Subclinical Hypothyroidism
  17. Dyspareunia (gyn, sx)
    1. Review of Dyspareunia and underlying conditions
  18. Shared Decision Making (manage, communication)
    1. Updated Patient Communication
  19. Sinusitis (ent, sinus)
    1. Reviewed Sinusitis imaging for complications
  20. Thrombosed Hemorrhoidectomy (gi, procedure)
    1. Updated technique
  21. Burn Debridement (surgery, procedure)
    1. Added Burn Debridement
  22. Fever Without Focus Management 2 to 24 months (id, peds)
    1. Updates to serious Bacterial Infection in children and the approach to the age 2-24 months (previously 3-36 months)
  23. Methohexital (psych, pharm)
    1. Added short acting Barbiturate for Procedural Sedation
  24. Methanol Poisoning (er, toxin)
    1. Expanded on Methanol Poisoning management
  25. Ankle Fracture (ortho, ankle, Fracture)
    1. Updates related to complications and management
  26. Dietary Sodium (renal, pharm)
    1. Added common sources of excessive Dietary Sodium
  27. Polycythemia Vera (hemeonc, marrow)
    1. Updated general approach to diagnosis and management
  28. Nasolaryngoscopy (ent, procedure)
    1. General Updates to indications and procedure
  29. Compartment Syndrome (ortho, neuro)
    1. Updates to evaluation and management
  30. Gabapentin (neuro, pharm)
    1. Added additional toxicity information (esp. Renal Insufficiency)
  31. Acne Rosacea (derm, acne)
    1. Updates on management including the place for expensive topicals (e.g. Minocycline)
  32. Epistaxis (ent, nose)
    1. Updates to home management and prevention
  33. Hearing Impaired Person (ent, hearing)
    1. Added a page for approaches to communication
  34. Sodium Channel Blocker (cv, pharm)
    1. Added a page for box Sodium Channel Blocker Antiarrhythmics and Sodium Channel Blockers in general
  35. Lamotrigine (neuro, pharm)
    1. New precautions related to risk for Arrhythmia in those with Cardiovascular Risk Factors
  36. Covid19 (lung, id)
    1. Various updates including Vaccination and long-term complications

VI. Updates: May 2021

  1. Median Nerve Block at Wrist (surgery, pharm)
    1. Updated, along with Radial Nerve Block at Wrist as well as complete wrist block
  2. Central Alpha Adrenergic Antagonists (cv, pharm)
    1. Reviewed Aldomet, Guanfacine and Clonidine
  3. Distal Radius Fracture
    1. Completed images on Radial Inclination, radial length, Volar Tilt
  4. Mesenteric Ischemia (surgery, cv)
    1. Extensive updates to types of Mesenteric Ischemia and their management
  5. Emergent Reversal of Anticoagulation (hemeonc, pharm)
    1. Reviewed reversal agents (Idarucizumab, Andexanet Alpha) and their indications
  6. Cerebrospinal Fluid Leak (er, neuro)
    1. Reviewed CSF Leak and Pneumocephalus in Skull Fracture
  7. Presynaptic Alpha Adrenergic Antagonists (cv, pharm)
    1. Differentiated from postsynaptic alpha antagonists (e.g. Hytrin)
    2. Reviewed Reserpine and similar drugs, that are rarely used, but fills in for completeness and historical perspective
  8. Sports Physical (sports, exam)
    1. Overall review and added Relative Energy Deficiency in Sport (RED-S)
  9. Phenobarbital (psych, pharm)
    1. Added Phenobarbital including for Alcohol Withdrawal, as well as Barbiturates
  10. Labetalol (cv, pharm)
    1. Labetalol and Carvedilol updated and expanded
  11. Hypoglycemia Management (endo, Hypoglycemia)
    1. Additional management of Insulin Overdose added
  12. Respiratory Failure (lung, failure)
    1. Additional differentiation between Bellows Failure, hypercarbic failure, hypoxemic failure
  13. In-Flight Medical Emergency (id, travel)
    1. Reviewed Inflight Emergency background and management
  14. Nonaccidental Trauma (prevent, child)
    1. A few imaging updates added
  15. COVID-19 (lung, id)
    1. Updated Covid testing options
    2. mRNA Vaccine storage Temperatures and administration reviewed
    3. Adverse effects of Johnson and Johnson Vaccine (rare thrombosis and Thrombocytopenia)
  16. Mifepristone and Misoprostol Protocol for Early Pregnancy Loss (ob, bleed)
    1. Reviewed protocol (also used in Termination of Pregnancy)
    2. Also added/updated pages on individual agents
  17. Hypermobility Syndrome (rheum, exam)
    1. Added Generalized Joint Hypermobility Diagnosis (Beighton Hypermobility Score, Five Point Hypermobility Questionnaire)
    2. Extensive updates to Ehlers-Danlos Syndrome (EDS) including the Hypermobile and classic subtypes
  18. Humeral Shaft Fracture (ortho, Shoulder)
    1. Updates to evaluation and management
  19. Eravacycline (id, pharm)
    1. New Tetracycline class IV antibiotic
  20. Glyphosate Poisoning (er, toxin)
    1. Herbicide Poisoning
  21. Lunate Dislocation (ortho, wrist)
    1. Added Isolated Lunate Dislocation reduction as well as the 3 types of Lunate Dislocation
  22. Wolff-Parkinson-White Syndrome (cv, ekg)
    1. Added EKG images for SVT converting to sinus rhythm with WPW and delta waves
  23. Electrocardiogram in Myocardial Infarction (cv, ekg)
    1. Added EKG images for Hyperacute T Waves evolving to STEMI
  24. Urethritis (urology, sx)
    1. Updated causes and management
  25. Neonatal Resuscitation (nicu, exam)
    1. General updates
  26. Cardiac Tamponade (cv, Pericardium)
    1. Evaluation and management updates
  27. Magnesium Replacement (renal, pharm)
    1. Updates to dosing
  28. Phosphate Replacement (renal, pharm)
    1. Updates to dosing
  29. Hypokalemia (renal, pharm)
    1. Updates to dosing
  30. Code Status (geri, prevent)
    1. Approach to emergent Code Status discussion
  31. Preprint Reports (manage, research)
    1. Precautions regarding relying of preliminary data
  32. Antipsychotic (psych, pharm)
    1. Reviewed adverse effects
  33. Thiazide Diuretics (cv,pharm)
    1. Chlorthalidone and Indapamide are preferred over Hydrochlorothiazide
  34. Migraine Headaches (neuro, Headache)
    1. Consider Amerge and Frova for longer lasting Migraines (agents have longer onset of action)
  35. Topical Corticosteroids (derm, pharm)
    1. Reviewed systemic side effects
  36. Benedrex (ent, pharm)
    1. Old intranasal Decongestant is abused by ingestion, intravenously or by large inhalation
    2. Risk of Arrhythmia, Chest Pain, Psychosis, death when misused

VII. Updates: April 2021

  1. HIV New Diagnosis (hiv, exam)
    1. Updated initial management of HIV
  2. Cerebrospinal Fluid Examination (neuro, lab)
    1. Extensive updates to evaluation and interpretation
  3. High Altitude Ilness (er, environ)
    1. Updates to prevention and management
  4. Tick Borne Illness (ed, derm)
    1. Updated Lyme Disease, Babesiosis, and Anaplasmosis
    2. Also updated Vector Borne Disease and West Nile Virus
  5. ACE Inhibitors (cv, htn)
    1. Updated excretion, Renal Dosing, pregnancy and Lactation
  6. Loop Diuretics (cv, pharm)
    1. Extensive updates
  7. Retropharyngeal Abscess (ent, mouth)
    1. Updated imaging and differential diagnosis
  8. Phalanx Fracture (ortho, hand)
    1. Updated Phalanx Fracture management as well as Proximal Phalanx Fractures
  9. Open Cardiac Massage (cv, procedure)
    1. Updated Emergency Thoracotomy to include compression technique
  10. Necrotizing Fasciitis (derm, Bacteria)
    1. Updated Necrotizing Fasciitis and Gas Gangrene
  11. S2 Heart Sound (cv, exam)
    1. Expanded on findings and physiology
  12. Electrocardiogram in Myocardial Infarction (cv, ekg, cad)
    1. Added V8, V9 leads for posterior MI evaluation
  13. Cardiac Output (cv, exam)
    1. Expanded on cardiac ouput and Ventricular Preload physiology
  14. Delafloxacin (id, pharm)
    1. A relatively new Fourth Generation Fluoroquinolone indicated for Skin and Soft Tissue Infection
    2. Oral coverage (and IV) includes MRSA, Pseudomonas, Enterococcus
  15. Cyclopeptide Mushrooms (er, toxin)
    1. Hepatotoxic mushroom ingestions (esp. aminata phalloides)
  16. Serratus Anterior Nerve Block (surgery, pharm)
    1. Updated
  17. Spontaneous Pneumothorax (lung, er)
    1. Updates including Chest Tube discontinuation protocol
  18. Topical Corticosteroid (derm, pharm)
    1. Updated Corticosteroid selection, adverse effects, risks, potency, prescription quantities
  19. Forearm Fracture (ortho, Forearm)
    1. Extensive updates including Forearm Fracture in Children, Distal Radius Fracture, Radial Head Fracture
  20. Pain Management in Labor (ob, pharm)
    1. Updated Pain Management in Labor
    2. Updated Non-Pharmacologic Pain Control in Labor
    3. Updated Epidural Anesthesia and Combination Regional Anesthesia in Labor
  21. Sternoclavicular Dislocation (ortho, Shoulder)
    1. General updates on acute SC Dislocation management
  22. Potassium-Sparing Diuretic (cv, pharm)
    1. Updated Triamterene, Amiloride, Spironolactone and Eplerenone
  23. Ubrogepant (neuro, pharm)
    1. Updates
  24. Chlorine Bleach Ingestion (er, toxin)
    1. Updates
  25. Wiggers Diagram (cv, exam)
    1. Completed Cardiac Cycle diagram (Wiggers Diagram)
  26. Acute Nicotine Poisoning (psych, cd)
    1. Added Nicotine Poisoning management (esp. children)
  27. Respiratory Physiology (lung, anatomy)
    1. Added
  28. Oxygen Saturation (lung, exam)
    1. Added Oxyhemoglobin Dissociation Curve graph
  29. Diuretics (cv, pharm)
    1. Added Mannitol, updated Acetazolamide, Thiazide Diuretics
  30. Tick Removal (id, procedure)
    1. Updates
  31. Eye Trauma (eye, Trauma)
    1. Additional pearls in blunt pediatric Eye Trauma, Hyphema
  32. Posterior Shoulder Dislocation (ortho, Shoulder)
    1. Additional evaluation and management pearls
  33. Octreotide (gi, pharm)
    1. Added this somatostatin mimic with broad endocrine activity
  34. Baclofen Poisoning (rheum, pharm)
    1. Added Baclofen Poisoning
  35. Suicidality (psych, depression)
    1. Updates
  36. Covid-19 Vaccine (lung, id)
    1. Additional Vaccine updates
  37. Lipoglycopeptide Antibiotic (id, pharm)
    1. Added the long acting Vancomycin-like agents (along with some reorganization of glycopeptide antibiotics)
  38. Spontaneous Coronary Artery Dissection (cv, cad)
    1. Additional updates
  39. Asthma Exacerbation Management in the ER (lung, Asthma)
    1. Updates
  40. Vascular Access (er, iv)
    1. Reviewed Vascular Access options
  41. Erenumab (neuro, pharm)
    1. Erenumab (Aimovig) is a CGRP Antagonist for Migraine Prophylaxis
    2. Associated with 60 cases of systolic increase of 40 mmHg, diastolic increase of 30 mmHg
    3. Occurred within 1 week of first or second dose
    4. May be related to the blockade of CGRP which is a vasodilator
  42. Tofacitinib (id, pharm)
    1. Monoclonal Antibody in Rheumatoid Arthritis and Psoriasis with a growing list of black box warnings
    2. Serious infections, Thrombosis, Cardiovascular events, Lung Cancer, Increased mortality
  43. Antibiotic Bolus Dosing (id, pharm)
    1. Reviewed antibiotics that may be given as IV bolus
  44. Hemorrhagic Disease of the Newborn (nicu, hemeonc)
    1. Added topic
  45. Adrenal Insufficiency (endo, adrenal)
    1. Updates to emergent management
  46. Bowel Preparation (gi, procedure)
    1. A few more protocols added
  47. Systolic Failure (cv, chf)
    1. Verquvo is another expensive med with mild benefit as adjunct to HFrEF management
  48. Tranexamic Acid (hemeonc, pharm)
    1. Additional efficacy data added
  49. Buprenorphine (psych, pharm)
    1. EMS initiated withdrawal protocol with Buprenorphine (Cooper University Hospital, Camden, NJ)

VIII. Updates: March 2021

  1. Hormonal Contraception (gyn, Contraception)
    1. Added quick start protocol for initiating Hormonal Contraception
  2. Entrapment Neuropathy (ortho, neuro)
    1. Extensive updates
  3. Severe Asthma (lung, Asthma)
    1. Extensive updates, especially regarding Asthma Biologics, Breathing Exercises in Asthma, Asthma Differential Diagnosis
  4. Bipolar Disorder (psych, bipolar)
    1. Extensive updates on evaluation, diagnosis, management
  5. Akathisia (neuro, motor)
    1. Added with differential diagnosis and management
  6. Adult Health Maintenance Screening (prevent, hme)
    1. Updated, esp. in context of Health Maintenance in Women
  7. Frailty (geri, exam)
    1. Complete revision of topic including evaluation and interventions
  8. Jaw Dislocation (dental, jaw)
    1. Updated anterior relocation technique with additional clarification
  9. Calcium (renal, lab)
    1. Added Calcium Homeostasis image
  10. Potassium (renal, lab)
    1. Added Potassium Homeostasis image
  11. Acute Pancreatitis (gi, Pancreas)
    1. Updated imaging (Ultrasound, CT)
  12. Images (gen)
    1. Added Sodium-Potassium ATPase Pump to medical fables
  13. Bell's Palsy (neuro, cn)
    1. Updated regarding non-idiopathic cases (e.g. Lyme Disease)
  14. Mobitz Mobitz II AV Block (cv, ekg)
    1. Non-conducted P Waves may not follow a pattern
  15. Clevidipine (cv, pharm)
    1. Added another Dihydropyridine Calcium Channel Blocker for Hypertensive Emergency
  16. Electrocardiogram (cv, exam, ekg)
    1. Various updates including adding a page on ST Segment (had one on ST Elevation)
    2. Reviewed cardiac electrophysiology
    3. Added EKG images
  17. Stingray (er, derm)
    1. Updated Marine Envenomations by Stingrays and related venomous fish
  18. Iron Toxicity (hemeonc, pharm)
    1. Updates to evaluation and management
  19. Trigger Point Injection (rheum, procedure)
    1. Updated Trigger Point Injection, as well as Myofascial Pain Syndrome, Musculoskeletal Injury Management
  20. Clonidine (cv, pharm)
    1. Updated Preoperative Guidelines for Medications Prior to Surgery to reflect Clonidine patch caveats
    2. Updated Clonidine for transition from oral to transdermal
    3. Thanks to Howard Kreisler, PharmD for email communication
  21. Locked Knee Syndrome (ortho, knee)
    1. Expanded on Knee Locking in meniscal tear
  22. Wernicke's Encephalopathy (psych, neuro)
    1. Added MRI findings
  23. Right Ventricular Hypertrophy (cv, Myocardium)
    1. Updated EKG findings and related associations with Pulmonary Hypertension, tricuspid insufficiency
  24. Novichok Poisoning (er, toxin)
    1. Updated Nerve Agents
  25. Emergency Psychiatric Evaluation (psych, exam)
    1. Varius updates including to Suicidality
  26. Emergency Hysterotomy (er, ob, Trauma)
    1. Updates to the procedure technique
  27. Concussion (er, neuro)
    1. General updates
  28. Trauma Evaluation (er, Trauma)
    1. Assorted updates, especially regarding Hemorrhage Management
  29. Hand Hygiene (id, prevent)
    1. More evidence that you should wash your hands
  30. Drugs of Abuse (psych, cd)
    1. Synthetic Cannabinoids and Synthetic Cathinones are updated
  31. Cervical Artery Dissection (neuro, cv)
    1. Added Cervical Artery Dissection and Carotid Artery Dissection (Vertebral Artery Dissection was already present)
  32. Aortic Dissection (cv, vessel)
    1. Acute Aortic Dissection Score (ADD-RS) or D-Dimer positive is an indication for CT Imaging
    2. Added hypoperfusion syndrome presentations
  33. COVID-19 (lung, id)
    1. Added Johnson and Johnson Vaccination
  34. Intramuscular Injection (er, pharm)
    1. Reviewed Vaccine technique (thanks to prescriber's letter and ACIP)
  35. Single Maintenance and Reliever Therapy (Asthma, pharm)
    1. Protocol uses maintenance combination Inhaler for extra doses prn exacerbation
    2. Reduced systemic steroids, ED Visits, hospitalizations (NNT 16)
  36. Irritable Bowel Syndrome (gi, bowel)
    1. Various updates on management and separated out FODMAPs into its own topic
  37. Prediabetes (endo, dm)
    1. Reviewed progression to diabetes prevention strategies
  38. Urge Incontinence (uro, Bladder)
    1. Another expensive beta-3 agonist (Gemtesa)
  39. Anti-Retroviral Therapy (hiv, pharm)
    1. Cabenuva (Cabotegravir and Rilpivirine) is an IM monthly injection that appears as effective as triple oral therapy

IX. Updates: February 2021

  1. Gonorrhea (id, std)
    1. Gonorrhea management is now Ceftriaxone 500 mg IV or IM for one dose (or if ceph. allergic, Gentamicin 240 mg IM and Azithromycin 2 g orally for one dose)
    2. Cefepime is still not recommended, but if no alternative, Cefixime 800 mg orally once
    3. Chlamydia management if not excluded (not indicated for Gonorrhea treatment without Chlamydia as of 2020)
    4. If treating for Chlamydia also, Doxycycline 100 mg twice daily for 7 days is preferred as of 2020 (alternative is Azithromycin 1 g orally for 1 dose)
  2. Hip Pain (ortho, hip)
    1. Extensive updates to various causes of Hip Pain
    2. Many cases of Trochanteric Bursitis are actual Gluteal Tendinopathy
    3. Piriformis Syndrome is one of many causes of Sciatica grouped under Deep Gluteal Syndromes
  3. Labor Dystocia (ob, LD)
    1. Various updates to Labor Dystocia and its management
  4. Dysphagia (neuro, sx)
    1. Extensive updates on Dysphagia, Esophageal Dysmotility, oropharyngeal dysmotility and Swallowing Evaluation for Oropharyngeal Dysphagia
  5. Ceftazidime-Avibactam (id, pharm)
    1. Expanded on Ceftazidime and Ceftazidime-Avibactam, as well as Beta-Lactamase
  6. Thallium Poisoning (er, toxin)
    1. Added topic to Poisonings
  7. Elbow Dislocation (ortho, elbow)
    1. Expanded on Elbow Dislocation and its reduction
  8. Transient Ischemic Attack (neuro, cv)
    1. Added additional admission criteria, prognosis factors
  9. QTc Prolongation (cv, exam, ekg)
    1. Updated additional causes
  10. Caffeine Toxicity (pharm, nutrition)
    1. Updated toxicity for the world's most commonly used psychoactive substance
  11. Acid-Base Homeostasis (renal, lab)
    1. Expanded Acid-Base Homeostasis, Arterial Blood Gas, ABG Interpretation, Anion Gap and Metabolic Acidosis
    2. Created a diagram for pH buffering
    3. Created a nomogram (also including link for the code)
    4. Created an interactive ABG Interpreter with graph
  12. Endoscopic Intubation (lung, procedure)
    1. Added orotracheal endoscopic variation to fiberoptic Nasotracheal Intubation
  13. LVH with Repolarization Abnormality (cv, Myocardium, ekg)
    1. ST and T Wave changes may normally accompany LVH
    2. Critical to exclude Acute Coronary Syndrome from LVH with Repolarization Abnormality
  14. Calcium Homeostasis (renal, lab, Calcium)
    1. Reviewed Calcium balance mechanisms
  15. Compartment Syndrome (ortho, neuro)
    1. Specific compartments and overall Fasciotomy technique reviewed in general
  16. Phenibut (pharm, alternative)
    1. Supplement marketed for anxiety and sleep has toxicity risks including Agitated Delirium, significant sedation and withdrawal
  17. Popliteal Sciatic Nerve Block (surgery, pharm)
    1. Expanded on procedure and technique
  18. Telemedicine Musculoskeletal Evaluation (manage, computer)
    1. Reviewed Telemedicine approach to Shoulder Exam, Elbow Exam, Hand Exam, Wrist Exam
    2. Reviewed Telemedicine approach to Hip Exam, Knee Exam, Ankle Exam
  19. Free Water Clearance (renal, lab)
    1. Added the calculation and interpretation of Free Water Clearance
  20. Targeted Cancer Therapy (hemeonc, pharm)
    1. Extensive review of agent types (esp. Small Molecule Inhibitor-Mediated Chemotherapy)
  21. Sexual Assault (prevent, abuse)
    1. Updates to the evaluation and management for Sexual Assault
  22. Chest Pain in Older Adults (cv, geri, cad)
    1. Reviewed elderly presentations of Acute Coronary Syndrome, Pulmonary Embolism and Aortic Dissection
  23. Pregnancy Induced Hypertension (cv, ob)
    1. Updates to PIH, mild PIH, Severe PIH and HELLP Syndrome
  24. Pneumonia (lung, id)
    1. Chest XRay has a Test Sensitivity of only 43% in Community Acquired Pneumonia
  25. Mechanical Ventilation (lung, procedure)
    1. Important nuances to managing Metabolic Acidosis in the intubated patient (all about Respiratory Rate)
  26. Pulmonary Embolism in Pregnancy (lung, ob, cv)
    1. Various updates
  27. Cerebral Vein Thrombosis (neuro, cv, hemeonc)
    1. Added CVT and its various presentations, epidemiology, pathophysiology and management
  28. Community Acquired Pneumonia (lung, id)
    1. IDSA (2019) updates including diagnostic criteria, antibiotic management (which is now 5 days)
  29. Pancreatic Enzyme (gi, pharm)
    1. Added Pancreatin (e.g. creon) as Pancreatic Enzyme Replacement and its true, non-hyped indications
  30. COVID-19 (lung, id)
    1. Various updates (e.g. quarantine, Ivermectin efficacy unclear, Tocilizumab does not seem to work)
    2. New Ellume home Covid test
    3. More on Covid-19 Vaccine
  31. Adjunctive Acne Vulgaris Management (derm, acne)
    1. Winlevi is a new androgen receptor inhibitor in acne (may not have benefit over other agents, and expensive)
  32. Septal Hematoma Evacuation (ent, nose)
    1. Expanded on procedure technique

X. Updates: January 2021

  1. COVID-19 (lung, id)
    1. Monoclonal Antibodies (Casirivimab/Imdevimab and Bamlanivimab) are among the most promising COVID-19 treatements as of December 2020
    2. FDA Emergency Use Indications include Confirmed positive COVID-19 testing AND High Risk Patients for Serious Complications
    3. Contraindications include patient NOT hospitalized for COVID-19 AND not requiring Supplemental Oxygen for COVID-19; Thank you to Dr. Joe Weidner for email feedback
    4. Also added Covid-19 Vaccines
  2. Infective Endocarditis (cv, id)
    1. Extensive updates to the evaluation, diagnosis and management of Infective Endocarditis
  3. Cytokine Release Syndrome (hemeonc, pharm)
    1. Until 2020, primarily a complication seen with Chemotherapy (CAR T-Cell Therapy)
    2. The "Cytokine Storm" of COVID-19, and some of its proposed management follows the Cytokine Release Syndrome playbook
  4. Spontaneous Coronary Artery Dissection (cv, cad)
    1. Common cause of Acute Coronary Syndrome in young women (esp. following delivery) and ages 45-53 years old
  5. Sodium and Water Homeostasis (renal, Lab)
    1. Expanded on Renal Function physiology
    2. Added diagrams for Total Body Water and Sodium and Water Homeostasis
  6. Methanethiol (er, toxin)
    1. Toxic, colorless, putrid smelling gas found in industry, nature and the mammalian gut
  7. Rimegepant (pharm, Headache)
    1. Rimegepant, a dissolving tablet, is another CGRP Antagonist for Migraine Headaches
  8. Knee Dislocation (ortho,knee)
    1. Total Knee Arthroplasty (TKA) may be complicated by Knee Dislocation in up to 0.5% of cases
    2. Emergent Management of TKA Knee Dislocation is the same as for native knees with the same neurovascular complication risks
    3. Revision surgery for instability may be needed
  9. Pheochromocytoma (endo, adrenal)
    1. Updates regarding imaging
  10. Chest Pain (cv, sx)
    1. Added INTERCHEST Chest Pain Rule, Marburg Heart Score and CAD Pretest Probability in Chest Pain Presentation
  11. Peripheral Neuropathy (neuro, sx)
    1. Broad review of Peripheral Neuropathy and its causes, based on symmetric or asymmetric (focal), and its evaluation
  12. Cervical Spondylotic Myelopathy (ortho, c-spine)
    1. In-depth review of Cervical Myelopathy, a condition with both UMN deficits and LMN deficits
    2. Also added associated abnormal reflexes, some of which I was surprised were still absent after FPNx20 years (e.g. Babinski Reflex, Ankle Clonus, Romberg Test)
  13. Ropivacaine (surgery, pharm)
    1. Preferred Anesthetic for Regional Anesthesia
    2. LAST Reaction presents with neurotoxicity (confusion) in contrast to cardiac toxicity and Arrhythmia for Bupivacaine
  14. Superficial Cervical Plexus Nerve Block (surgery, pharm)
    1. Regional Anesthesia for the lateral neck
  15. Erector Spinae Plane Block (surgery, pharm)
    1. New Regional Anesthesia technique for chest wall coverage of the hemithorax
    2. May replace Serratus Anterior Nerve Block and intercostal Nerve Block
    3. However, does not offer pleural Anesthesia (may be ineffective in Chest Tube placement)
    4. Includes new diagram for injection
  16. Ultrasound-Guided Interscalene Brachial Plexus Block (surgery, pharm)
    1. Regional Anesthesia for proximal, and radial aspect of arm
    2. Includes new diagram for injection
  17. Suprascapular Nerve Block (surgery, pharm)
    1. Provides Anesthesia to the medial Shoulder
    2. Includes new diagram for injection
  18. Regional Anesthesia (surgery, pharm)
    1. Added Ultrasound Guided Ankle Block and Ultrasound Guided Wrist Block
    2. Added Facial Nerve Block image
    3. Added Touhy and Bevel Needle Images
  19. Calming the Agitated Patient (psych, behavior)
    1. Midazolam is very effective within 15 minutes, but has a short half life that often requires additional doses or adjunctive medications
  20. Finger Extensor Tendon Repair (ortho, hand)
    1. Reviewed extensor tendon repair indications, contraindications and technique (Kessler)
  21. Interleukin-6 Receptor Antagonist (rheum, pharm)
    1. Reviewed Tocilizumab and similar agents used in Cytokine Release Syndrome and Rheumatologic Conditions
  22. Paralytic Shellfish Poisoning or Saxitoxin (er, toxin)
    1. Ingestion of seafood (esp. clams and mussels) contaminated with the NeurotoxinSaxitoxin, not killed on cooking, not detected by taste or smell
    2. Onset within 30-60 min (up to 120 min, or even 24 hours) of progressive neurologic symptoms with risk of paralysis and Respiratory Failure
  23. Lower Gastrointestinal Bleeding (gi, sx)
    1. Added additional evaluation and management nuances including Antiplatelet Therapy discontinuation guidelines
  24. Vasopressin (cv, pharm)
    1. Added Vasopressin (ADH), mechanisms, dosing, adverse effects
  25. Emergency Management of Atrial Fibrillation (cv, ekg)
    1. Added additional precautions in unstable Atrial Fibrillation with RVR (including Diastolic Dysfunction)
  26. Pulmonary Edema (renal, lung)
    1. Added differential diagnosis of Pulmonary Edema - divided into Cardiogenic Pulmonary Edema and Non-Cardiogenic Pulmonary Edema
  27. Septic Joint (rheum, id)
    1. Added Hip Arthrocentesis, Arthrocentesis and additional Septic Arthritis pearls
  28. Eating Disorder (psych, eating)
    1. Extensive updates in Eating Disorders in general as well as specific conditions
  29. Breast Cancer Screening (gyn, prevent)
    1. Updated Breast Cancer epidemiology, BRCA1, BRCA2, Breast Cancer Risk Factors and Breast Cancer Screening
  30. Cancer Risk due to Diagnostic Radiology (rad, ct)
    1. Updated regarding specific radiation exposures per imaging study
  31. Skull Trephination (neuro, procedure)
    1. Update procedure as well as Epidural Hematoma
  32. Postpartum Hemorrhage (ob, ld, bleed)
    1. Consider Bakri Balloon (large enough to stabilize bleeding via tamponade within Uterus)
  33. Cardiovascular Disorders in Pregnancy (cv, ob)
    1. Pregnancy is associated with several serious complications (Aortic Dissection, coronary dissection, CVA, PIH)
  34. Midline Venous Catheter (er, procedure)
    1. Higher rate of extravasation
    2. Use as long of an intravenous catheter as possible (Thread as much of the catheter inside the vein)
    3. Use Ultrasound in both in-plane (long axis) and out-of-plane (short axis) to reduce extravasation risk
  35. Pediatric Intubation (lung, procedure)
    1. Reviewed Advanced Airway pearls in children
  36. Neurologic Red Flags in Acute Eye Presentation (eye, sx)
    1. Additional eye presentation-related neurologic red flags added
    2. Also reviewed causes of eye related CN palsies (CN 3, CN 4, CN 6)
  37. Hydrogen Peroxide Poisoning (er, toxin)
    1. Added to Caustic Ingestions (also risk of air embolism)
  38. Anhidrosis (derm, sweat)
    1. Reviewed causes of Anhidrosis and Hypohidrosis
  39. Child Abuse (prevent, abuse, child)
    1. Updates to evaluation and management
    2. Added Munchausen Syndrome by Proxy (Medical Child Abuse)
  40. Omega-3 Fatty Acid (cv, pharm)
    1. Omega-3-Fatty Acids as of 2021 do not appear to significantly lower cardiovascular risk
  41. Plenity (endo, Obesity)
    1. Cellulose hydrogel taken with water before meals, expands in Stomach and reduces capacity
    2. Indicated in BMI 27-40 with normal gastrointestinal motility and anatomy
    3. Plenity 3 capsules with 16 ounces water taken 20-30 min before lunch and before dinner
    4. Patients lose 2% more than Placebo in 6 months (similar to Orlistat) at $100 per month and have increased Flatulence and bloating
  42. Dry Eye (eye, sx)
    1. Eysuvis is a new expensive steroid for severe Dry Eyes
  43. Systolic Dysfunction (cv, chf)
    1. Added reminders for confirming Medication Compliance while
  44. Antidepressant Induced Sexual Dysfunction (psych, med)
    1. Additional pearls added for managing Sexual Dysfunction with Antidepressants
  45. Aging Skin (derm, environ)
    1. Added additional management for Wrinkles
  46. Sore Throat Symptomatic Treatment (ent, pharm)
    1. Expanded on treatment pearls (and cannot believe I still had Codeine as a treatment option - removed)

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