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Syncope Evaluation: Evidence-Based and Economical
This study eliminated low-risk syncope patients and those with non-syncope transient loss of consciousness, such as seizure and head trauma, using a structured approach in the emergency department (ED), with only high-risk syncope patients being admitted. These high-risk syncope patients made up 28% of the patients included in the study. After admission, a simplified Wells’ pulmonary embolism criteria score was calculated, and a D-dimer was obtained. If either was high, the patient was scanned for PE and 17% were found to be positive, with two-thirds of those being found to have large-vessel pulmonary emboli. The bottom ...
Source: The Hospitalist - July 5, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: Clinical Guidelines Source Type: research

Mr. M
Dr. Migliore I step off the subway, up the elevator, and up several flights of stairs. There’s a homeless man there who always uses the last stair of the lower staircase as a tray for his food. And by tray, I mean he sets his half-eaten rice burrito directly onto the step and picks around at it while I imagine the guacamole is mixing with Hep B and C. diff and MRSA. He looks up at me, I promise myself for the 100th time I’m going to start carrying cash or Kind bars or something; I give him my best sheepish face, and emerge at street level. I walk toward my hospital and pass a gentleman who sits on a ledge next to the ...
Source: The Hospitalist - December 1, 2022 Category: Hospital Management Authors: Lisa Casinger Tags: Essay Source Type: research

Sodium-containing Acetaminophen Intake Increases the Risk of CVD and All-cause Mortality
Dr. Hoque Clinical question: Does the use of sodium-containing acetaminophen increase the risk of cardiovascular disease (CVD) and all-cause mortality in patients with and without a history of hypertension when compared to non-sodium-containing acetaminophen? Background: There is a common misconception that excess sodium intake comes primarily from dietary sources. The excipients of common over-the-counter medications such as some formulations of acetaminophen may contain significant amounts of sodium. For example, a 500-mg dose of soluble acetaminophen contains 390 mg of sodium, and a 500-mg dose of effervescent acetamin...
Source: The Hospitalist - October 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: In the Literature Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research