Family Practice Notebook Updates

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

II. 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

III. 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)

IV. 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

V. 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

VI. 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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