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