II. Updates: December 2022
-
Systemic Lupus Erythematosus (rheum, diffuse)
- Updated with 2019 ACR/EULAR diagnostic criteria
- Thanks to Komkwuan Paruchabutr for bringing the 2019 guidelines to my attention
-
Relative Bradycardia (cv, ekg)
- Updated causes including Relative Bradycardia with Hypotension
-
Shock Index (cv, exam)
- Updated, including added Diastolic Shock Index
-
Massive Hemorrhage Protocol (hemeonc, pharm)
- Updates including to Hemorrhage Management
-
FAST Exam (er, rad)
- Updates
-
Modified Sgarbossa Criteria (cv, ekg)
- Updates
-
Heart Transplant (cv, surgery)
- Updates regarding denervation, ekg, infection and rejection
-
Transplantation (surgery, prevent)
- Updates related to Solid Organ Transplant, Transplant Rejection, Stem Cell Transplant
-
Cholangitis (surgery, gi)
- Extensive updates
-
Dexmedetomidine (surgery, pharm)
- Updates
-
Biosimilars (id, pharm)
- Updates, including Adalimumab, which will now have up to 12 new Biosimilars in 2023
- Warfarin (hemeonc, pharm)
-
Hormone Replacement (gyn, pharm)
- Updates including Vaginal Estrogen
-
Calcium Channel Blockers (cv, pharm)
- Updates to various drugs within class
-
Musculoskeletal Injury (er, Trauma)
- Updates to specific nerve injuries (also updated Motor Exam and Sensory Exam)
-
Burn Injury (er, environ)
- Updated fluid management
-
Medication Route (pharm, medication)
- Added
-
Drug Metabolism (pharm, medication)
- Extensive updates
-
STONE Score (urology, exam)
- Added
-
Ureterolithiasis (urology, renal)
- Updates
-
Mesenteric Ischemia (surgery, gi)
- Extensive updates
-
Tobacco Cessation (psych, cd)
- Updates
-
Post-Covid Long-Term Effects (lung, id)
- Added
-
Adult Immunization (id, immunize)
- Updates
-
Sports Related Trauma (er, sports)
- Updates including Sideline Medical Evaluation
-
Nocturnal Enuresis (urology, peds)
- Extensive updates
-
Montreal Cognitive Assessment (neuro, exam)
- Added
-
Edema (renal, edema)
- Updates
-
Vasomotor Symptoms of Menopause (gyn, sx)
- TSEC added
-
Hydrocortisone (endo, pharm)
- Updates
- SGLT Inhibitors (endo, pharm)
- Updates
-
Tongue Laceration (ent, Tongue)
- Added
-
Hospital Discharge Planning (geri, manage)
- Individualized discharge plans result in shorter hospital stays and lower readmission rates in older patients (over age 60 years)
-
Transitions of Care (geri, prevent)
- Extensive updates regarding indications and options
- Also added Longterm Care definitions
-
Monkey Pox (id, virus)
- Updates regarding STD related cases
-
COPD Exacerbation (lung, copd)
- Doxycycline has fallen out of favor for Antibiotic Use in COPD Exacerbation due to lack of efficacy
- Thank you to Justin Chua, DNP for alerting me to this recommendation
- Ibuprofen (pharm, Analgesic)
-
Hypopigmentation (derm, exam)
- Updated
-
Slipped Capital Femoral Epiphysis (ortho, peds)
- Updated
-
Verquvo (cv, pharm)
- Added
-
Procalcitonin (hemeonc, lab)
- May allow shortening of Antibiotic course in Sepsis and respiratory infections without adversely affecting outcomes
-
Knee Osteoarthritis Management (rheum, Osteoarthritis)
- Triamcinolone 40 mg gluteal IM had equivalent efficacy compared with intraarticular injection at 8 and 24 weeks
- However, intraarticular injection was superior to IM at 4 weeks
-
Osteoporosis Management (rheum, bone)
- Updates
-
Sepsis (id, fever)
- Updates
-
Pharmacology (pharm, medications)
- Added with definitions and mechanisms
- Also added an entry on Drug Metabolism
III. Updates: November 2022
-
Vegetarian Diet (pharm, nutrition)
- Added Vegetarian Diet with extensive review
-
Nutrition Guidelines (pharm, nutrition)
- Extensive Updates
-
Calciphylaxis (renal, derm)
- Added with extensive review
-
Percutaneous Nephrostomy (urology, surgery)
- Added
-
Chest Pain Plus (cv, sx)
- Added DDX and addressed in STEMI presentations
-
Moyamoya Disease (cv, vessel)
- Added
-
Neurocritical Intubation (er, neuro)
- Updates, including adding the term
-
Amyotrophic Lateral Sclerosis (neuro, motor)
- Extensive updates
-
Endometriosis (gyn, Uterus)
- Extensive updates
-
Placental Abruption (ob, antepartum)
- Updated with CT for high mechanism Blunt Abdominal Trauma
- Reviewed specific findings and False Positives
-
Sexually Transmitted Infection (id, std)
- Updates
-
Sexual Assault (prevent, abuse)
- Extensive updates to the history, exam and specimen collection
-
Acute Cholecystitis (surgery, gi)
- Updated regarding CT imaging
-
Covid19 Bivalent Booster Vaccine (id, immunize)
- Added bivalent booster information
-
Immunizations (id, immunize)
- Updates
-
Monkeypox (id, virus)
- Added Tecovirimat dosing
-
Continuous Glucose Monitor (endo, pharm)
- Updates
-
Sulfa Allergy (id, pharm)
- Updates
-
NSAID Renal Adverse Effects (pharm, renal)
- Updates
-
Blood Urea Nitrogen (renal, lab)
- Updates (thanks to Dr. Juan Fernandez for feedback)
-
Polymyalgia Rheumatica (rheum, diffuse)
- Extensive updates, including to Giant Cell Arteritis
-
Medications that Exacerbate Heart Failure (cv, pharm)
- Updates
-
Psoriasis (derm, hyperplasia)
- Updates with a few newer, expensive medications
-
Linear Dermatitis (derm, exam)
- Added
- Gastoparesis (gi, Stomach)
- Updates
-
Bariatric Surgery (endo, surgery)
- Added image of surgery types
-
Femur Traction Splint (ortho, procedure)
- Added
-
Hip Dislocation (ortho, hip)
- Updates
-
Orthostatic Hypotension (cv, exam)
- Updates
-
Barrett Esophagus (gi, hemeonc)
- Updates
- Breast Cancer Gene Marker (gyn, lab)
-
Intrahepatic Cholestasis of Pregnancy (derm, gi)
- Updated with extensive review
-
Schizophrenia (psych, Psychosis)
- Updates
-
Tricyclic Antidepressant (psych, pharm)
- General updates as well as to Amitriptyline and Nortriptyline
-
Spiritual Assessment (psych, exam)
- Added
-
Emergency Medical Services (er, manage)
- Updates
-
Dinitrophenol Poisoning (er, toxin)
- Added
IV. Updates: October 2022
-
Opioid Use Disorder (psych, cd)
- Updated, esp. related to Buprenorphine
-
Alcoholic Ketoacidosis (psych, cd)
- Added
-
Thrombocytopenia (hemeonc, Platelets)
- Extensive updates
-
Geriatric Emergency Care (geri, prevent)
- Updates
-
Tuberculosis (lung, Tb)
- Updates
-
Bell's Palsy (neuro, cn)
- Updates regarding Bell's Palsy in Children
-
Malaria (id, Parasite)
- Extensive updates
-
Procalcitonin (id, lab)
- Updates
-
Parenteral Iron (hemeonc, pharm)
- Updated regarding infection risk
-
Clostridioides difficile (gi, Diarrhea)
- Updates to Fidaxomicin
-
Cephalosporin (id, pharm)
- Updates
-
Bursitis (ortho, sx)
- Updates
-
Influenza Vaccine (id, Vaccine)
- Updates
-
Monkeypox (id, virus)
- Updates
-
Systolic Dysfunction (cv, chf)
- Updates regarding management in Chronic Kidney Disease
-
Xerostomia (ent, sx)
- Updates
-
Serotonin Syndrome (psych, pharm)
- Updates
-
Hearing Aid (ent, pharm)
- Updates
-
Functional Constipation (gi, Constipation)
- Updates
-
Gastroprotection (gi, pud)
- Updates on oupatient GI prophylaxis indications
-
Vulvovaginal Candidiasis (gyn, id)
- Updates regarding recurrent candida Vaginitis management
-
Preterm Labor (ob, antepartum)
- Updates
-
Gestational Diabetes (endo, ob)
- Updates
-
Carbamazepine Poisoning (neuro, pharm)
- Added to Carbamazepine
-
Ectopic Pregnancy (ob, antepartum)
- Updates
-
Yawning (lung, sx)
- Added
-
Community-Acquired Pneumonia (lung, Bacteria)
- Updates regarding IDSA 2019 guidelines for Sputum Culture and Blood Culture indications
-
Eye Irrigation (eye, procedure)
- Updates
-
Talus Fracture (ortho, ankle)
- Updates
-
Depression in Older Adults (psych, geri)
- Updates
-
Aspirin (pharm, Analgesic)
- Updated Aspirin indications regarding Cardiac Risk Management
-
Erythema Nodosum (derm, rheum)
- Updates, esp. causes
-
Rheumatoid Arthritis Remittive Agents (rheum, ra)
- Updates
V. Updates: September 2022
-
Hepatitis B Vaccine (id, immunize)
- Universal Hepatitis B Vaccine is recommended for all adults under age 60 years
-
Insect Bites (er, derm)
- Extensive updates
-
Diverticulitis (gi, bowel)
- Extensive updates
-
Clogged Feeding Tube (gi, procedure)
- Updates
-
Tracheostomy (lung, procedure)
- Updates
-
Status Asthmaticus (lung, Asthma)
- Updates
-
In-Flight Medical Emergency (id, travel)
- Added inflight Vaginal Delivery guidance
-
Venous Catheter Site Bleeding (er, procedure)
- Added Woggle Technique
-
ST Elevation (cv, exam)
- Updated causes
-
Takayasu Arteritis (rheum, cv)
- Updates
-
Cardiopulmonary Resuscitation in Pregnancy (er, ob)
- Added the ACLS Mnemonic ABCDEFG for differential diagnosis
-
ST Elevation (cv, exam)
- Updates to diffuse ST Elevation
-
Pediatric Advanced Life Support (er, exam)
- 2019 guideline updates
-
Cervical Artery Dissection (neuro, cv)
- Updates
-
Abdominal Aortic Aneurysm (surgery, cv)
- Updated
-
Scrotal Mass (urology, sx)
- More updates
-
Transcutaneous Pacing (cv, procedure)
- Added
-
Multiple Sclerosis (neuro, demyelinating)
- Extensive Updates
-
Neurologic Multimodal Prognostication After Cardiac Arrest (er, exam)
- Added to ROSC management
-
Anxiety Disorder (psych, anxiety)
- Various updates to Anxiety Disorders, GAD, panic and their management
-
Hemophagocytic Lymphohistiocytosis (hemeonc, marrow)
- Added
-
Iron Supplementation (hemeonc, pharm)
- Oral iron is as effective as Parenteral Iron in preventing Blood Transfusion and mortality
- Oral iron is preferred in those without significant malabsorption or other barriers to oral ingestion
-
G6PD Deficiency (hemeonc, Hemolysis)
- Important updates to Medications in G6PD Deficiency
- Updates including class system, epidemiology, pathophysiology
-
Laryngospasm on Induction (lung, procedure)
- Updates
-
Statin Intolerance (cv, pharm)
- Updates
-
SMART Asthma Management Protocol (lung, pharm)
- Updates to protocol
-
Aloxi (gi, pharm)
- Corrected Aloxi dose (thanks to Deepa Chacko)
-
LAST Reaction (surgery, pharm)
- Corrected dosing (after giving Intralipid for ED patient, post-dental procedure with Lidocaine neurotoxicity)
-
Prolonged QT Interval due to Medication (cv, pharm)
- Updated
-
Potassium Competitive Acid Blocker (gi, pharm)
- Added this new class (PCAB) with Vonoprazan (Takecab) - the prototype drug
- Potassium Competitive Acid Blocker (PCAB) blocks both active and resting proton pumps, with activity onset within hours regardless of timing with meals
- Contrast with Proton Pump Inhibitors, which block only active proton pumps, with full action delayed up to 7 days, and best taken 30 to 60 minutes before a meal
-
Vaccination (id, immunize)
- For kindergarden entry, 94% of children are up to date on Vaccination in U.S. (79 to 98% depending on state)
- In the U.S., only 60% of teens were current on routine Vaccination pre-Covid19 in 2020 (trending down since then)
-
Lyme Disease (id, vector)
- Updates
-
Direct Oral Anticoagulant (hemeonc, pharm)
- Added precautions related to dosing
-
Aphthous Ulcer (ent, mouth)
- Updates with additional treatment options
-
Superficial Folliculitis (derm, hair)
- Updates
-
Left Atrial Appendage Closure Device (cv, procedure)
- Reduces stroke risk when implanted after cardiac surgery for other reason
-
Pediatric Fractures (ortho, peds)
- Ultrasound is accurate for upper extremity Fracture detection (except at the elbow)
-
Lisfranc Fracture Dislocation (ortho, foot)
- Updates
-
Myositis Ossificans (ortho, hip)
- Updates
-
Antibiotic Associated Diarrhea (id, pharm)
- Probiotics reduce risk (NNT 13 to 20)
-
Green Nail Syndrome (derm, nail)
- Updates
-
Drug-induced Photosensitivity (derm, pharm)
- Updates
-
Dexmedetomidine (surgery, pharm)
- Dexmedetomidine (Precedex) is now available in sublingual form
-
Colonoscopy Bowel Preparation (gi, procedure)
- Updated
-
Constipation Management (gi, Constipation)
- Updated protocols
-
Triptan Overdose (neuro, pharm)
- Added info to Triptan page
-
Dispelling Health Misinformation (manage, communication)
- Added the 3C approach
-
Shared Decision Making (manage, communication)
- Extensive updates including NICE guidelines, numerical data best practices and three talk model
-
Medical Cannabis (gi, pharm)
- Updates
VI. Updates: August 2022
-
Brainstem CVA (neuro, cv)
- Added various Brainstem Syndromes (thanks to Dr. Sourabh Jain)
-
Intracerebral Hemorrhage (neuro, cv)
- Updates
-
Spinal Epidural Abscess (ortho, id)
- Updates
-
Drowning (sports, water)
- Extensive updates
-
Active Female (sports, gyn)
- Updates including to RED-S (replaces Female Athlete Triad), Exercise in Pregnancy
-
Abdominal Pain in Pregnancy (surgery, ob)
- Updates including imaging the RLQ
-
Preeclampsia Prevention (cv, ob)
- Consistent Exercise initiated in early pregnancy reduces the risk of developing Gestational Hypertension and Preeclampsia
-
Blood Type (hemeonc, lab)
- Updates to Blood Type, INR, Clotting Pathway, Perioperative Anticoagulation
-
Retropharyngeal Abscess (ent, mouth)
- Updates
-
Intranasal Analgesics in Children (pharm, peds)
- Updates
-
Esophageal Rupture (gi, Esophagus)
- Updates
-
Inflammatory Bowel Disease (gi, ibd)
- Updates
-
Rectal Prolapse (gi, Rectum)
- Updated including reduction technique
-
Low Back Pain (ortho, sx)
- Updates, including Low Back Pain Red Flags
-
Patellar Fracture (ortho, knee)
- Updates
-
Celiac Disease (gi, malabsorption)
- Updates
-
Acute Pancreatitis (gi, Pancreas)
- Updates
-
Acute Diarrhea (gi, Diarrhea)
- Updates
-
Perirectal Abscess (gi, Rectum)
- Updates
-
Pilonidal Abscess (gi, Rectum)
- Updates
-
Urinalysis (urology, lab)
- Extensive updates to all components of the Urinalysis
- Alzeimers Disease (neuro, cognitive)
- PrecivityAD is a lab marketed for age 60 years old and older with Cognitive Impairment
- Combines 2 tests: ApoE Genotype and Abeta 42 to Abeta 20 ratio
- Generates a proprietary Amyloid Probability Score, estimating the likelihood for Alzheimers Disease
-
Erythroderma (derm, hyperplasia)
- Updates
-
Scrotal Swelling (urology, sx)
- Updates
-
Infantile Hemangioma (derm, peds)
- Propranolol is FDA approved for age 5 weeks and older
- Well tolerated and very effective at facilitating Hemangioma involution when used in the first year of life
- Start in first months of life to prevent proliferation and continue for 6 months
- Dose: 1 mg/kg (max 2-3 mg/kg/dose) orally twice daily, given after feeding to prevent Hypoglycemia
-
Depression Medical Management (psych, depress)
- Updates
-
Covid19 (lung, id)
- Updates regarding Pxlovid including specific Drug Interactions
-
Head Lice (derm, Parasite)
- Abametapir (Xeglyze) is another agent soon available to treat Head Lice
-
pSOFA Score (id, fever)
- Added, thanks to Dr. Sourabh Jain
-
APACHE Score (GI, Exam)
- Updated to link to APACHE 4 Calculator, thanks to Dr. Sourabh Jain
- Tirzeptatide (endo, pharm)
- Tirzeptatide (Mounjaro) is a GLP1-Agonist, but also a GIP Agonist
- In combination with Metformin, reduces Hemoglobin A1C up to 2.3%
- Weight loss in Diabetes Mellitus patients may approach 25 pound loss in 10 months
- Same adverse effects and risks as with GLP-1 Agonists
-
Seborrheic Dermatitis (derm, dermatitis)
- Updates
-
Collagen Supplement (pharm, alternative)
- Added
-
Medical Precepting (manage, communication)
- Added
-
Giapreza (cv, pharm)
- Updates
-
Methotrexate Toxicity (rheum, pharm)
- Updates
-
Social Media (prevent, computer)
- Updates, and a resource added to The Social Dilemma Movie
-
Gastrointestinal Bleeding Management (gi, sx)
- Updated intubation management thanks to Dr. Sourabh Jain
-
Cardiac CT Calcium Scoring (cv, rad)
- Updates
-
Cachexia in Cancer (hemeonc, endo)
- Updates
VII. Updates: July 2022
-
Sodium Nitrite Poisoning (er, toxin)
- Added
-
Unknown Ingestion (er, toxin)
- Updated with precautions regarding newer combinations used in online Suicide kits
-
Cellulitis (derm, Bacteria)
- Updates, including Necrotizing Fasciitis, severe Cellulitis empiric regimen
-
Negative Pressure Wound Therapy (surgery, procedure)
- Added
-
Community Acquired Pneumonia (lung, id)
- Extensive updates
-
Monkeypox (id, virus)
- Added
- Clostridiodes difficile (gi, id)
- Updated Antibiotic coverage
-
Pneumococcal Vaccine (id, immunize)
- Another reminder that pneumococcal Vaccination has been simplified
- Prevnar 20 is sufficient alone in most adults with Pneumococcal Vaccine Indications
- Herd Immunity from Primary Series in children has markedly reduced invasive pneumococcus in elderly
-
Superior Vena Cava Syndrome (cv, vessel)
- Updates to Superior Vena Cava Syndrome and to Generalized Edema Above the Diaphragm
-
Splenic Rupture
- Spontaneous Splenic Rupture is seen in Infectious Mononucleosis (EBV) with Splenomegaly
- Spontaneous rupture accounts for 50% of Infectious Mononucleosis related Splenic Rupture cases
-
Preoperative Examination in Children (surgery, exam)
- Added with extensive coverage
-
Water Intoxication (renal, Sodium)
- Water Intoxication, beer potomania, Tea and Toast Syndrome share a similar mechanism for Hyponatremia
- Patient with excessive hypoosmolar fluid intake (free water, beer, tea) and low solute diet (low Sodium intake)
- Intake exceeds the renal capacity for free water excretion (50 to 100 meq/L or mOsm/L, specific gravity <1.003)
-
Calcium Supplementation (renal, Calcium)
- Updated absorption
-
Myasthenia Gravis (neuro, motor)
- Updates
-
Cerebrovascular Accident (neuro, cv)
- Updates
- Finger Fracture (ortho, hand)
- Finger Dislocation (ortho, hand)
- Updates
-
Pelvic Fracture (ortho, hip)
- Updates
-
Lumbar Surgery (ortho, surgery)
- Added
-
Laceration Repair (surgery, derm)
- Scattered updates
-
Regional Anesthesia (Surgery, Pharm)
- Multiple updates and revisions based on the excellent HQMedEd Regional Anesthesia course at HCMC
- Added 5 new diagrams for added blocks
-
PENG Regional Anesthesia (Surgery, Pharm)
- Another method for Regional Anesthesia of the hip
-
Axillary Nerve Block (Surgery, Pharm)
- Added
-
Supraclavicular Brachial Plexus Block (Surgery, Pharm)
- Added
-
Xylazine Toxicity (psych, cd)
- Adrenergic alpha-2 Agonist (similar to Clonidine, Dexmedetomidine) with central acting decrease in sympathetic tone
- Used as a Sedative, Analgesic and centrally acting Muscle relaxant in veterinary medicine
- Street name, "Horse Tranquilizer", added to injection Drugs of Abuse (e.g. Fentanyl, Cocaine) to enhance euphoria
- Associated with Opioid Overdose deaths, and unresponsive to Naloxone
-
Cannabinoid Hyperemesis (psych, cd)
- Capsaicin cream may work on vanilloid receptors in Hypothalamus (similar to the action of a hot shower)
- Apply 0.075% Capsaicin cream as a thin film every 4 hours until symptoms resolve
- Apply cream to 15 x 25 cm or palm sized area periumbilical area using a gloved finger
- Peak effect in 20-30 minutes and lasts 3 hours
-
Premature Ejaculation (urology, sx)
- Added
-
Emergency Contraception (gyn, pharm)
- Mirena IUD (Levonorgestrel-releasing) has similar efficacy to Copper-T IUD for EC
-
Intrauterine Device (gyn, Contraception)
- Studies support longer duration for IUD use
- Copper T-380A (Paragard) IUD: 10 years (studies support 12 years of use)
- Mirena: 7 year Levonorgestrel IUD (originally labelled for 5 years)
-
Depo Provera (gyn pharm)
- Self-administered Depo Provera Subcutaneous (SQ) dosing is off label but supported by CDC, WHO
-
Aspirin (pharm, Analgesic)
- Falling out of favor in the primary prevention of lower risk patients without Myocardial Infarction or stroke (NNT 250 for first CV event)
- Benefits may not outweigh the risks of GI Bleeding, Hemorrhagic CVA (NNH 200)
-
Insect Repellent (id, pharm)
- Updated
-
Agitation in Dementia (neuro, cognitive)
- Updated
-
PDE5 Inhibitor (urology, pharm)
- Blurred Vision or Vision Loss (Retinal Detachment, Optic Neuropathy), with higher risk in atherosclerosis
- Vision Loss can be permanent and appears to occur with all PDE5 Inhibitors
- Incidence may be as high as 16 in 10,000
-
Orexin Antagonist (urology, pharm)
- Added Quviviq (Daridorexant), another expensive sleep aid
-
D-Dimer Discriminatory Values in Pulmonary Embolism (hemeonc, lab)
- Added PEGeD protocol related discriminatory values
-
DVT Prevention in Travelers (hemeonc, prevent)
- Updates
- Iritable Bowel Syndrome
- Ibsrela (Tenapanor) is another expensive agent for Constipation dominant iritable bowel syndrome
-
Soft Tissue Mass
- Added
-
Plantar Fibromatosis (ortho, foot)
- Updates
-
Nodular Tenosynovitis (ortho, hemeonc)
- Added
-
Liposarcoma (hemeonc, Sarcoma)
- Added
-
Dermatofibrosarcoma Protuberans (hemeonc, Sarcoma)
- Added
-
Leiomyosarcoma (hemonc, Sarcoma)
- Added
-
Rhabdomyosarcoma (hemeonc, Sarcoma)
- Updated
-
Hypothyroidism (endo, Thyroid)
- TSH elevations are often transient in the elderly (often during non-Thyroid related acute conditions)
- Exercise caution when starting Thyroid Replacement in the elderly, and consider rechecking TSH after acute illness
- Thanks to Dr. Joe Weidner for the pearl
VIII. Updates: June 2022
-
Pediatric Constipation (gi, peds)
- Extensive updates
-
Acute Radiation Syndrome (er, toxin)
- Added a thorough review of Radiation Syndrome
-
First Seizure Evaluation (neuro, Seizure)
- Extensive updates
-
Pediatric CVA (neuro, cv)
- Expanded differential diagnosis
-
Telangiectasia (derm, exam)
- Added extensive review
-
Subtalar Dislocation (ortho, foot)
- Added this high energy, rare foot dislocation
-
Prevention of Kidney Disease Progression (renal, prevent)
- Limiting Dietary Sodium intake (e.g. <2300 mg/day) lowers Blood Pressure and decreases albuminuria
- Postpartum Care (ob, postpartum)
-
Sexually Transmitted Infection (id, std)
- Updates
-
Mycoplasma Genitalium (id, std)
- Added
-
Intimate Partner Violence (prevent, abuse)
- Updated
-
Mycetoma (derm, id)
- Added
-
Psoriasis (derm, hyperplasia)
- Updates to management
-
Foreign Body Granuloma (surgery, derm)
- Added a brief summary of this complication of retained Skin Foreign Body
-
Vasomotor Symptoms of Menopause (gyn, sx, endo)
- A few updates and corrections to SNRIs
-
Deep Vein Thrombosis (hemeonc, cv)
- Created a deep vein image
-
Post-Thrombotic Syndrome (hemeonc, cv)
- Review of topic, diagnosis, grading, management and prevention
-
Tendinopathy (sports, ortho)
- Updated Peroneal Tendinopathy, Posterior Tibial Tendinopathy, Anterior Tibial Tendinopathy
- Added Ankle Anatomy diagram (Muscles and tendons)
-
Joint Pain (rheum, sx)
- Added additional evaluation guidance
-
Down Syndrome (neuro, Disability)
- Updates to the Health Maintenance of adults with Down Syndrome
-
Insulin Pump (endo, pharm)
- Updates
-
Metabolic Syndrome (endo, dm)
- Updates
- Type 2 Diabete Mellitus (endo, dm)
- Indications to add SGLT2 Inhibitor or GLP-1 Receptor Agonist (which are associated with lower mortality)
- Established cardiovascular disease or Chronic Kidney Disease (esp. SGLT Inhibitor)
- Four or more Cardiovascular Risk Factors
-
Peanut Allergen Powder (ent, pharm)
- Updates
-
Traveling with Medications (id, travel)
- Updates
-
Decubitus Ulcer Prevention (surgery, derm)
- Updates
-
Parkinson's Disease Management (neuro, Tremor)
- Updates
-
Spinal Cord Injured Patient (prevent, hme)
- Regular Physical Activity improves aerobic capacity, balance and walking ability
- Improves Activities of Daily Living, global function, Major Depression and sleep quality
-
Prevention of Ischemic Stroke (neuro, prevent)
- Updates
-
Condom (gyn, Contraception)
- Updates
-
Chest XRay (lung, rad)
- A few additions including spine sign
-
Tobacco Cessation (psych, cd)
- Behavioral interventions are effective (with or without pharmacotherapy)
- Individual or group counseling
- Guaranteed financial incentives
- Text message-based counseling
-
Hydrocarbon Ingestion (er, toxin)
- Expanded on Hydrocarbon definitions, examples, pathophysiology, evaluation and management
-
Atrial Fibrillation Synchronized Cardioversion (cv, ekg)
- Electrical Cardioversion results in earlier discharge compared with chemical cardioversion for CHADS 0 to 1
-
Thiazide Diuretic (cv, pharm)
- Chlorthalidone is more potent than Hctz (lowers SBP 10 mmHg more)
- Hctz immediate release only covers daytime Hypertension
-
Lung Cancer (lung, hemeonc)
- Extensive updates to Lung Cancer, Non-Small Cell Lung Cancer, Small Cell Lung Cancer
- Also updates to Lung Nodule (approach changed in 2017) and Lung Cancer screening (approach changed in 2021)
-
Prostate Cancer Screening (urology, hemeonc)
- MyProstateScore (MPS) is two urinary biomarkers: Prostate CancerAntigen 3 (PCA3), TMPRSS2:ERG Gene Fusion
- Consider in patients referred for Prostate biopsy
- Cost of $760 is not covered by medicare or medicaid
-
COPD Pulmonary Rehabilitation (lung, sports)
- Virtual Pulmonary Rehab or Telerehabilitation (phone call, phone app, computer, video conference)
- As effective as in-person rehab in reducing breathlessness and increasing walk distance in COPD
-
Livedo Reticularis (rheum, exam)
- Added, with updates to Polyarteritis Nodosa and Takayasu Arteritis
-
Lateral Canthotomy (eye, procedure)
- Updates
-
Hypopyon (eye, exam)
- Expanded on differential diagnosis including Pseudohypopyon
- Also Added endogenous Bacterial endophthalmalitis
-
Macular Degeneration
- VEGF Inhibitor Ocular Implant containing Ranibizumab (Susvimo) is inserted via a small incision in pars plana and Sclera
- Similar to VEGF Inhibitor Intravitreal Injections that require reservoir refill via needle only every 24 months
- As effective as intravitreal injection, but with Endophthalmitis risk (1.7%) is higher with implants than with injection (0.5%)
- Conjunctival Hemorrhage, hyperemia ad Iritis are common initial adverse effects in first month
-
Hypertrophic Cardiomyopathy (cv, Myocardium)
- Extensive updates to diagnosis, evaluation, management including specific guidelines in pregnancy, athletes, pilots, truck drivers
-
Covid19 Monoclonal Antibody (lung, pharm)
- Bebtelovimab is a Monoclonal Antibody effective in omicron variants
-
PreHevbrio (id, immunize)
- Three Antigen recombinant Hepatitis B Vaccine indicated as a Hepatitis B Vaccine option in non-pregnant adults
- This Tri-Antigenic Vaccine Appears more immunogenic than other, single Antigen preparations
- However, associated with more local pain, as well as myalgias, Headache, Fatigue than with the other preparations
- As with most other Hepatiis B Vaccines, administer in 3 doses at 0, 1, and 6 months
-
Ventricular Tachycardia (cv, ekg)
- Additional features that make Ventricular Tachycardia more likely than SVT with aberrancy
- Right bundle branch morphology of the QRS (RSR' or "rabbit ears")
- Fusion Beats (supraventricular and ventricular waves fuse to form an irregular QRS)
-
Intravenous Contrast for Abdominopelvic CT (surgery, rad)
- Updates
-
Low Back Pain Management (ortho, l-spine)
- Antispasmodics/Muscle relaxants once again show no benefit and increased adverse effects
-
Hospital Support for Lactation (ob, Lactation)
- Infant Carrier may increase the rate of Breast Feeding at 6 months
IX. Updates: May 2022
-
Urethral Stricture (urology, Urethra)
- Added complete review including diagnosis and management
- Oral Lesion (dental, mucosa)
-
Venous Thromboembolism (hemeonc, cv)
- Extensive updates with a focus on recurrent VTE management
- Added two decision rules: HERDOO2 Model and Orbit Bleeding Risk Score
- Also updated Breakthrough VTE
-
Sleep Disorders (psych, sleep)
- Extensive updates
-
Sexually Transmitted Infection (id, std)
- Extensive Updates to Sexually Transmitted Infection, especially regarding gonorrohea and Chlamydia
- Include pharyngeal and rectal GC, Ch testing when indicated
-
Ulcerative Colitis (gi, ibd)
- Extensive updates
-
Ivabradine (cv, pharm)
- CHF agent - updated Drug Interactions, adverse effects, contraindications
-
Cascades of Care (manage, legal)
- Extra tests beget more tests
-
Shingles Vaccine (id, immune)
- Shingrix is now recommended for Immunocompromised patients, age >19 years
-
Alcoholic Hepatitis (gi, liver)
- Extensive updates
-
Lung Abscess (lung, id)
- Extensive updates
-
Near-Hanging (er, ent)
- Extensive Updates
-
Myocarditis (cv, id)
- General updates to the diagnostic approach
-
Nasal Fracture (ent, nose)
- Updates on imaging approach (skip the xray)
-
Hepatitis B Vaccine (id, immune)
- Hepaitis B Vaccine is recommended for all unvaccinated adults ages 19 to 59 years
-
Fever in the Returning Traveler (id, fever)
- Extensive updates
-
Intraosseous Line (er, procedure)
- Added image for access sites
-
Analgesic Overuse Headache (neuro, Headache)
- A few updates
-
Monkshood Poisoning (er, toxin)
- Added
-
Tetrahydrocannabinol (psych, cd)
- Delta-8 THC is a synthetic, chemically similar to THC (delta-9), but with risk of life threatening toxicity
-
Myasthenia Gravis (neuro, motor)
- Updates
-
Tick Borne Illness (er, derm)
- Updates
-
Alpha Gal Reaction (ent, allergy)
- Added
-
Powassan Encephalitis (neuro, id)
- Added
-
Southern Tick Associated Rash Illness
- Added
-
Gabapentin (neuro, pharm)
- Updates
-
Agitated Delirium (psych, behavior)
- Updates
-
Scaphoid Fracture (ortho, wrist)
- Short Arm Cast WITHOUT thumb appears as effective as Thumb Spica Cast, and with better hand function while casted
-
Elbow Ossification Centers (ortho, anatomy)
- Added image for Elbow Ossification Centers (CRITOE Mnemonic)
-
Homeopathy (pharm, alternative)
- Solutions so dilute, they may lack even a single molecule of "active" ingredient, but could have harmful contaminants
- Who knows? Not the consumer, and not the FDA or USP, since these are unregulated
-
Peptic Ulcer (gi, pud)
- Glycopyrolate was originally used in the 1960s for Peptic Ulcers to reduce gastric secretions
- However, since that time, much more effective medications are available (e.g. H2 Blockers, Proton Pump Inhibitors)
- Yet, in 2022 Dartisla ODT was released at $500/90 tablets, a 10 fold markup over generic glycopyrolate
- Avoid glycopyrolate (including Dartisla ODT) in Peptic Ulcer Disease (we have much better. less expensive treatments)
-
Fluoride Supplementation (pharm, mineral)
- Added dental varnish (had been included in Oral Health in Children)
-
Delayed Antibiotic Prescription (pharm, id)
- Example: Acute Sinusitis <10 days of symptoms (to start if symptoms refractory to non-Antibiotics at >10-14 days)
- Delayed Antibiotic Prescriptions result in decreased Antibiotic use, without adverse outcomes
-
Covid19 (lung, id)
- Added AAP Return to Play guidelines for child and teen athletes following Covid 19 infection
-
Preparticipation Physical Evaluation (sports, exam)
- Added Electrocardiogram precautions
-
Alcohol Intoxication (psych, cd)
- General updates
-
Hepatitis B Serology (gi, lab)
- Added another Serology interpretation table
-
Langerhans Cell Histiocytosis (hemeonc, marrow)
- Rare condition presenting in young children age<3 with atypical, refractory Seborrheic Dermatitis or Eczema
-
Plenity (endo, pharm)
- Updated
-
Mild Closed Head Injury (er, neuro)
- I-Stat TBI Plasma detects 2 markers of intracranial injury (UCH-L1, GFAP)
- May be used to risk stratify to Head CT Imaging in adults within 12 hours of Closed Head Injury with GCS 13 to 15
- CT Indicated if UCH-L1 > 327 pg/ml, or GFAP >22 22 pg/ml
- Test Sensitivity 97.6% for intracranial Head Injury and Negative Predictive Value 99.6%
-
Bacterial Meningitis (neuro, id)
- Updated decision rules
-
Alopecia Areata (derm, hair)
- Updated
-
Zinc Deficiency (pharm, minerals)
- Updated Zinc Deficiency and Zinc
-
Clinical Practice Guideline (manage, research)
- Updated with pitfalls, resources
X. Updates: April 2022
-
Sacroiliac Joint Dysfunction (ortho, L-spine)
- Extensive updates
-
Pediatric Murmur (cv, exam, peds)
- Extensive updates to Heart Murmur, Systolic Murmur, Diastolic Murmur, Congenital Heart Disease and Pediatric Murmur
-
Prevnar 20 (id, immunize)
- Pneumococcal Vaccine recommendations by CDC have changed every few years and are confusing
- Pneumococcal Vaccination is recommended for over age 65 years and those with risk factors
- As of 2022, Prevnar 20 ALONE replaces other Pneumococcal Vaccines
- If Prevnar 13 or Vaxneuvance are used for conjugate Vaccine, then also give Pneumovax 23 (at interval)
-
Telemedicine Diabetes Mellitus Evaluation (endo, exam, dm)
- Provider and nurse diabetes Telemedicine visits improve outcomes and glycemic control (esp. Type 2 Diabetes)
- Remote Glucose monitoring is among the most effective Telemedicine strategies
-
Corticosteroid (endo, pharm)
- Added Corticosteroid tapering indications (>3 weeks of use, disease flare expected on stopping)
- Also added physiology related information
-
Thalassemia (hemeonc, Hemoglobin)
- AFP Journal has an excellent review of Thalassemia in March 2022 issue
- Article brings into focus the management and complications of Thalassemia based on transfusion dependent or not
- Extensive updates to a topic that I feel I understand much better after reading this article
- Also completed a Hemoglobin diagram
-
Fever Without Focus Management Birth to 3 Months (id, peds)
- Extensive updates to the well appearing febrile infant protocol that changed in fall of 2021
- Medications in Lactation (ob, pharm)
-
Menstrual Cycle (gyn, exam)
- Extensive additions to the physiology of the Menstrual Cycle including a new diagram
-
Intussusception (surgery, gi)
- Updates
-
Monteggia Fracture (ortho, elbow)
- Do not miss the Radial Head Dislocation!
- Added image for Forearm Fracture dislocations (GRUM)
-
Narrow Pulse Pressure (cv, exam)
- May predict circulatory collapse in Trauma with Hemorrhage
- Prehospital Narrow Pulse Pressure predicts severe Trauma and need for aggressive Resuscitation
- Interpret in combination with Trauma Evaluation and other markers (Hypotension, Shock Index)
-
Septic Olecranon Bursitis (ortho, id)
- Bursa Aspiration for Gram Stain and culture has been historically recommended in all cases of Septic Bursitis
- However, based on new ED based study, empiric Antibiotic management without aspiration may be a safe and effective strategy
-
Health Care Associated Infection (id, prevent)
- Updates to CAUTI, CRBI, VAP, C. difficile, Surgical Site Infection, Antibiotic Resistant Infection
-
Insulin (endo, pharm)
- Added additional information about Insulin U-500
-
Hyperparathyroidism (endo, Parathyroid)
- Extensive updates to Hypercalcemia and Hyperparathyroidism
- Also updated Hypocalcemia and Hypoparathyroidism
-
Hypopituitarism (endo, pituitary)
- Added
-
CT Angiography in Gastrointestinal Bleeding (gi, rad)
- Preferred test when Lower GI Bleed patient cannot undergo endoscopy, with significant Lower GI Bleeding
-
Cerebral Venous Thrombosis (neuro, cv)
- Updated risk factors, precautions, presentation, management
-
Cerebral Arteriovenous Malformation (neuro, cv)
- Added, and also added Arteriovenous Malformation
-
Cerebral T Waves (cv, ekg)
- Associated with large Intracranial Hemorrhage (also seen in cerebral edema, Ischemic CVA, PRES)
- Typically in precordial leads, and T Inversion may be >20 mm
- May be associated with Prolonged QTc
-
Altered Level of Consciousness in Children (neuro, peds)
- Added with an extensive protocol and differential diagnosis
-
Pneumonia Management in Children (id, lung)
- Updates regarding Antibiotic selection and shorter durations (5 days)
-
Psychological First Aid (psych, exam)
- Added lay person intervention in Suicidality
-
Buprenorphine (pharm, Analgesic)
- Added dental decay related adverse effects
-
Melatonin (pharm, alternative)
- Updates regarding safety (not recommended in pregnancy and Lactation), may cause Growth Delay in children
- Updated dosing in children
-
Diabetic Neuropathy (endo, neuro)
- Updates on medication management
-
Acute Angle-Closure Glaucoma (eye, Glaucoma)
- Updated exam and management
-
Buprenorphine (pharm, Analgesic)
- Oral Buprenorphine preparations (e.g. buccal, sublingual) may increase risk of Tooth Decay
-
Eczematous Dermatitis (derm, dry)
- Added new agents (monoclonal antibodies, JAK Inhibitors)
-
Flecainide Overdose (cv, pharm)
- Reviewed toxicity findings and management
-
Body Packer (er, toxin)
- Additional management including Whole Bowel Irrigation added to protocol
-
Subcutaneous Hematoma Drainage (surgery, procedure)
- Added
-
Postoperative Oral Bleeding (dental, mucosa)
- Added based on author experiences
- Limited evidence for approaches gleamed from expert opinion, including otolaryngology
-
Hemophilia B (hemeonc, coags)
- Updates to management
-
Wound Closure with Staples (surgery, procedure)
- Added
-
Auricular Field Block (surgery, procedure)
- Updated
-
Retrograde Urethrogram (urology, procedure)
- Updated
-
Central Cord Syndrome (ortho, c-spine)
- Updated
-
Spinal Epidural Abscess (ortho, l-spine)
- Spinal Epidural Abscess is frequently misdiagnosed on initial presentation
- Be alert for red flag presentations (esp. with back pain)
- Unexplained fever is present in 86% of cases
- Focal neurologic deficits with progressive or disabling symptoms is present in 82% of cases
-
Tramadol (pharm, Analgesic)
- Additional Tramadol updates (many reasons to avoid)
- Read the Tox and the Hound (Tramadont)
-
PF Ratio (lung, lab)
- Allows interpretation of ABG PaO2 while on Supplemental Oxygen
-
Energy Metabolism (endo, exam)
- Added additional factors affecting Energy Metabolism
-
Ear Canal Bleeding after Cerumen Removal (ent, ear)
- Continuous Ear Canal Bleeding after Cerumen Removal by ENT lead to my learning of a quick trick to control bleeding (ear wick)
-
Ceftazidime-Avibactam (id, pharm)
- Updates
-
Phosphine Toxicity (er, toxin)
- Added
XI. Updates: March 2022
-
Maturity Onset Diabetes of the Young (endo, diabetes)
- MODY accounts for 1 to 5% of Diabetes Mellitus cases and often misdiagnosed as Type 1 or Type 2 Diabetes
- MODY is typically Autosomal Dominant (3 genetic defects account for >95% of cases)
- MODY results from non-autoimmune deficient Insulin secretion, with MODY 1 and MODY 3 typically requiring treatment
- MODY 1 and 3 are highly sensitive to Sulfonylureas (with Hypoglycemia risk), which often maintain efficacy for decades
-
Hemoptysis (lung, sx)
- Extensive updates
-
Borderline Personality Disorder (psych, behavior)
- Extensive Updates
-
Foot Drop (neuro, exam)
- Added a page on Foot Drop (thanks to Dr. Wesam Khalfalla for the suggestion)
-
Tracheostomy Obstruction (lung, procedure)
- Updates added to precautions in Hypoxia management
- Intranasal Ketamine (surgery, pharm)
- Updates with sedation dosing which are 2-4 fold higher dosing than the Analgesic dosing
-
Left Ventricular Hypertrophy Related EKG Changes (cv, ekg)
- Precautions regarding High Left Ventricular Voltage in healthy young patients, esp. athletes (not LVH)
-
Gastrointestinal Metabolism (gi, anatomy)
- Extensive updates to the physiology of Digestion including multiple diagrams
- Diagrams added for Carbohydrate Metabolism, Lipid Metabolism, Protein Metabolism and overall Digestion mechanisms
- Also created diagrams related to Glycolysis, Gluconeogenesis, Kreb Cycle
-
Intestinal Atresia (gi, peds)
- Added, and also updated malrotation and Midgut Volvulus
-
Respiratory Physiology (lung, anatomy)
- Finally completed a diagram of Lung Physiology
-
Hypothalamus (neuro, anatomy)
- Added Hypothalamus-Pituitary Hormone physiology diagram
-
Calcium Metabolism (renal, lab)
- Updated the Calcium Metabolism image to incorporate Vitamin D synthesis and activation
-
Thyroid Anatomy (endo, anatomy)
- Added Thyroid function diagram
-
Adrenal Gland (endo, anatomy)
- Added adrenal function diagram
-
Aldosterone (endo, lab)
- Added a topic on Aldosterone and mineralocortoid
-
Glucose Metabolism (endo, exam)
- Added diagrams for Gluconeogenesis (and Ketogenesis), Glycolysis and Carbohydrate Metabolism
-
Sleep Problems in Children (psych, peds)
- Extensive updates, including added Parasomnias
-
Unknown Ingestion (er, toxin)
- Extensive updates
-
Animal Bite (er, derm)
- Extensive Updates
-
Cervical Ripening (ob, ld)
- Updates to techniques
-
Labor Induction (ob, ld)
- Updated with Labor Induction indications including Gestational age criteria per condition
- Added Amniotomy
-
Nerve Agent Exposure (er, toxin)
- Updates
-
Sugammadex (neuro, pharm)
- Updates
-
Human Trafficking (prevent, abuse)
- Updates
-
Intracompartmental Pressure Monitor (ortho, procedure)
- Updates
-
Tracheal Suctioning (er, procedure)
- Updates
-
Fever of Unknown Origin (id, fever)
- Updates
-
Fluvoxamine (psych, pharm)
- Updates (due to increased adjunctive use for Covid, but mixed evidence of benefit)
- Cannabinoid Intoxication (psych, cd)
- Additional updates for accidental THC Intoxication in children
-
Inferior Shoulder Dislocation (ortho, Shoulder)
- Updates to management including Shoulder reduction of inferior dislocations
-
Closed Thoracic Lavage (lung, procedure)
- Added
-
Idiopathic Intracranial Hypertension (neuro, csf)
- Updated MRI findings
-
Intravenous Acetaminophen (pharm, Analgesic)
- IV Acetaminophen (Ofirmev) has had minimal use since release in 2010; costs $30/dose compared with $0.01 for oral Acetaminophen
- Use may increase when generic for perioperative patients as well as for NPO patients as adjunctive to NSAIDs and Opioids
XII. Updates: February 2022
-
Pediatric Pneumonia (lung, id)
- Consider occult Pneumonia in fever >5 days, Leukocytosis or Abdominal Pain
- Abdominal Pain is the presenting complaint in 8.5% of patients, age 3 to 14 years old (esp age <5 years)
- Vomiting or Diarrhea is present in 27% of Pediatric Pneumonia cases
-
Cardiac Syncope (cv, sx)
- Cardiac cause of Syncope is more likely in known cardiovascular disease (e.g. CAD, CHF, Atrial Fib), first episode after age 35 years
- Associated with no prodrome or prodromal Chest Pain or Shortness of Breath or Cyanosis
-
Covid19 (lung, id)
- Nirmatrelvir/Ritonavir (Paxlovid, Pfizer) is FDA emergency authorized, oral Protease Inhibitor
- Indicated in high risk outpatients started within first 5 days
-
Transient Global Amnesia (neuro, Amnesia)
- Transient inability to form new memories (Anterograde Amnesia) in episode lasting minutes to up to 24 hours
- One probable trigger is Valsalva Maneuver, which appears to cause transient MRI lesions in the Hippocampus
-
Vitamin D Toxicity (pharm, Vitamin)
- Expanded on topic
-
Subcutaneous Single Injection Digital Nerve Block (surgery, pharm)
- Another finger Anesthesia block technique
-
Essential Tremor (neuro, Tremor)
- Topiramate is now a first-line agent in Essential Tremor
- Drug Induced Tremor causes was also updated
-
Abdominal Trauma (er, gi)
- Bowel injury is rare (1-5%) in Blunt Abdominal Trauma, but easily missed when it does occur
- Bowel wall breaks and free air are seen in only a minority of bowel wall injuries
- Free fluid without solid organ injury is a red flag for intraabdominal injury
-
Adult Intussusception (surgery, bowel)
- Rare in adults (<0.08% of cases) and associated with malignancy in 15 to 65% of cases
-
Bacterial Endocarditis (cv, id)
- General Updates
-
Aortic Stenosis (cv, valve)
- General Updates
-
Septic Bursitis (ortho, id)
- Updates
-
Agitated Delirium (psych, behavior)
- Updated differential of the febrile Agitated Delirium patient
-
Staphylococcal Scalded Skin Syndrome (derm, id)
- Updates
-
Cluster Headache (neuro, Headache)
- Extensive updates
-
Adenomyosis (gyn, Uterus)
- Extensive updates
-
Orthostatic Hypotension (cv, exam)
- Extensive updates
-
Pruritus (derm, sx)
- Extensive updates
-
Arterial Atherosclerosis (surgery, cv)
- Updated interventions for AAA, Carotid Stenosis, Renal Artery Stenosis and Peripheral Arterial Disease
-
Positive Predictive Value (prevent, epi)
- Updated examples and links to calculator
-
Inhalation Injury (er, environ, burn)
- General updates
-
Venous Thromboembolism in Pregnancy (ob, hemeonc)
- Updates
-
Provider Burnout (manage, psych)
- Organizational prevention strategies added
-
PCSK9 Small Interfering RNA (cv, pharm)
- New Subcutaneous Injection for severe Hyperlipidemia
-
Covid19 (lung, id)
- Updates related to Paxlovid
-
Gastroesophageal Reflux (gi, Esophagus)
- Updates on PPI discontinuation
-
HIV PrEP (hiv, prevent)
- Updated options for management
-
Fertility Tracking (gyn, Contraception)
- Updates regarding Urine LH kits
-
Dual Antiplatelet Therapy (hemeonc, pharm)
- Status post coronary DES, use dual agents for 6 months, then Aspirin
- If high risk of bleeding (e.g. Gastrointestinal Bleeding), than use 3 months dual, 9 months Clopidogrel, then Aspirin daily
XIII. Updates: January 2022
-
Acute Aortic Occlusion (surgery, cv)
- Added
-
Arrhythmia Following Myocardial Infarction (cv, ekg)
- Added
-
Septic Arthritis (rheum, id)
- Extensive updates, including added Prosthetic Joint Infection
-
Pediatric Vomiting (gi, peds)
- Extensive updates to Pediatric Vomiting and Vomiting Causes in Children
-
Superior Mesenteric Artery Syndrome (surgery, gi)
- Added
-
Hepatitis C (gi, id)
- Extensive Updates
-
Cannabinoid (psych, cd)
- Extensive updates
-
Pneumonia in Children (lung, peds)
- Updates
-
Unprovoked Seizure in Children (neuro, Seizure)
- Added
-
High Sensitivity Troponin (cv, lab)
- Added protocol for High Sensitivity Troponin I
-
Thyroiditis (endo, Thyroid)
- Updates
-
Color Blindness (eye, Vision)
- Added
- Covid19 Vaccine (id, immunize)
- Pfizer Covid19 Vaccine approved for ages 5-12 years. Updated dosing
-
Covid19 (lung, id)
- Updated Venous Thromboembolism Prophylaxis in Covid19
-
Prevnar (id, immunize)
- Prevnar 20 is available for adults, pending approval in children
-
Dry Eyes (eye, sx)
- Intranasal Varenicline (Tyrvaya) is a approved intranasally at $600/month for modest effect on Dry Eyes
-
Subcutaneous Injection (er, procedure)
- Updates
-
Intramuscular Injection (er, procedure)
- Updates
- Seasonal Effective Disorder (psych, depression)
- Updates
-
Eczematous Dermatitis (derm, dry)
- Opzelura (Ruxolitinib) is a a topical JAK Inhibitor approved for refractory mild to moderate Eczema
-
Isotretinoin (derm, pharm)
- Updated
-
Citalopram Overdose (psych, pharm)
- Updated Citalopram and SSRI ovderose
-
Presbyopia (eye, Vision)
- Added topic as well as Vuity (Pilocarpine)
-
Septic Joint (rheum, id)
- Updates
-
Patella Dislocation (ortho, knee)
- Relocation updates
-
Ulnar Nerve Block (surgery, pharm)
- Updates
-
Aortoenteric Fistula (surgery, cv)
- Added
-
Fallopian Tube Torsion (gyn, ovary)
- Rare, isolated tube torsion added
-
Subarachnoid Hemorrhage (neuro, cv)
- Updates to diagnostic rules
-
Tube Thoracostomy (lung, procedure)
- Updates
-
Nutritional Support (pharm, nutrition)
- Reviewed Enteral Nutrition, Parenteral nutrition
-
Isoniazid Overdose (lung, pharm)
- Added
- Intravenous Angiotensin (cv, pharm)
- New agent for refractory Hypotension
-
Patient Education (manage, general)
- Updated, including misinformation
-
Benign Prostatic Hyperplasia (urology, Prostate)
- Updated management
-
Lybalvi (psych, pharm)
- Olanzapine/Samidorphan (Lybalvi) is released in 2021 at $1400/month
- Samidorphan is a Naltrexone derivative added to reduce weight gain that typically occurs with Olanzapine
- Marginal efficacy for cost (other strategies to reduce weight gain are preferred)
-
Prostate Cancer Management (urology, hemeonc)
- Reviewed Prostate Cancer hormonal management
-
Vaping (psych, cd)
- Updates
-
Turmeric (pharm, alternative)
- Updates