Family Practice Notebook Updates

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

II. 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-19Vaccines
  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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