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SOBRE EL AUTOR **

Mi foto
FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

EMU 365: Best Emergency Medicine Articles of the Year 2018

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martes, 15 de enero de 2019

SALAD

Emergency Physicians Monthly
Emergency Physicians Monthly - December 28, 2018 - By Long B & Koyfman A
..."Almost every emergency physician will face a challenging airway during their career. This may include the patient with severe facial trauma, a patient with severe angioedema or the patient with refractory hypoxia, despite preoxygenation. What about the patient with massive regurgitation and other material in the airway? The majority of the time, vomiting is a minor nuisance, but during intubation with high quantities of vomit or blood, aspiration and failure to obtain a definitive airway are real dangers. This article will discuss the standard Yankauer, the SALAD Park technique and intubation with a suction device..."


Infection & MI

PulmCrit (EMCrit)
PulmCrit - January 14, 2019 - By Josh Farkas 
"Summary The Bullet:
  • Myocardial infarction can be caused by any source of physiologic stress. Infection is no exception to this rule.
  • Myocardial infarction can be commonly diagnosed among patients with acute infection. However, most of these patients likely have type-II MI (demand ischemia), which doesn’t mandate specific therapy (e.g. anticoagulation, cardiac catheterization).
  • For patients presenting with infection, appropriate screening tools to look for myocardial ischemia include a history, physical examination, and EKG. If these tests reveal no evidence of ischemia, there is no indication to check a troponin.
  • Allow me to repeat this for emphasis: Neither influenza nor pneumonia are indications to check a troponin level.
  • Aggressively screening every influenza patient with a troponin will only degrade the positive predictive value of the test, leading to lots of false-positive results. This may trigger a cascade of inappropriate therapies (anticoagulation, beta-blockade, cardiac catheterization) with iatrogenic harm."

Chest Pain Pathway

emupdates
Emergency Medicine Updates - January 13, 2019 - By Reuben
Full pathway as png and pdf

Influenza Management

R.E.B.E.L.EM - January 14, 2019 - By Anand Swaminathan
Article: Uyeki TM et al. Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza. Clin Infect Dis 2018. PMID: 30566567
"Background: Influenza is an Emergency Department scourge that we deal with every year. The vast majority of patients recover from uncomplicated influenza without anything more than supportive care but, influenza can cause serious complications. Young children, older adults, pregnant and postpartum women, people with neurologic disorders and patients with certain chronic medical conditions (i.e. COPD, CAD, Diabetes, Immunocompromised states) are at increased risk for these complications. Annual vaccination is the best method to reduce the impact of influenza on morbidity and mortality. Though antiviral medications for influenza are far from perfect, the indications for their use must be understood..."

jueves, 10 de enero de 2019

Valproic Acid Toxicity

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emDocs - January 10, 2019 - Author: Yip K
Edited by: Tanen D, Santos C, Koyfman A and Long B
"Take home points
  • Check serial valproic acid levels to make sure it is downtrending.
  • CNS effects (e.g. somnolence, confusion) are most common.
  • Valproic acid induced hyperammonemia encephalopathy may be seen even without hepatotoxicity or elevated VPA levels.
  • Supportive care is key, though L-carnitine may be helpful."

Syncope vs Near-Syncope

REBEL EM - Emergency Medicine Blog
R.E.B.E.L.EM - January 07, 2019 - By Anand Swaminathan
"Authors Conclusions:
“Near-syncope confers risk to patients similar to that of syncope for the composite outcome of 30-day death or serious clinical event.”
Our Conclusions: 
In older adults (> 60 years of age), near-syncope appears to portend an equal risk of death or serious clinical event at 30 days when compared to syncope. These two entities should be considered as one when decisions are made in terms of evaluation in the ED.
Potential to Impact Current Practice: 
This data along with the work of Thirugnasambandamoorthy in 2015 has the potential to change the paradigm for many emergency clinicians who provide a different weight to syncope and near-syncope. This data should not be applied to patients < 60 as this group was not studied
Bottom Line: 
Near-syncope and syncope aren’t so different in terms of outcomes in older patients and should be considered equivalent presentations in terms of evaluation."

Oxigen for the acutely ill

thebmj
BMJ 2018; 363: k4169
 doi: https://doi.org/10.1136/bmj.k4169 (Published 24 October 2018) 
"What you need to know
  • It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation
  • A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in hospital
  • For patients receiving oxygen therapy, aim for peripheral capillary oxygen saturation (SpO2) of ≤96% (strong recommendation)
  • For patients with acute myocardial infarction or stroke, do not initiate oxygen therapy in patients with SpO2≥90% (for ≥93% strong recommendation, for 90-92% weak recommendation)
  • A target SpO2 range of 90-94% seems reasonable for most patients and 88-92% for patients at risk of hypercapnic respiratory failure; use the minimum amount of oxygen necessary"

miércoles, 9 de enero de 2019

Top 10 2018 ALiEM

Resultado de imagen de aliem
ALiEM - January 09, 2019 - By: Bryan D. Hayes
"Happy 2019 from the ALiEM team. We have published so many posts this year that you may have missed a few. Did you at least catch the top 10 ALiEM clinical posts in 2018? These are the most-viewed posts in the past calendar year. From can’t-miss ECGs, to common splint techniques, and new strategies for managing alcohol withdrawal – check these out as you keep celebrating the New Year!"

Cardiotoxic Drugs

R.E.B.E.L.Core Cast 2.0 - January 09, 2019 - By Anand Swaminathan
"Take Homes
  • Calcium Channel Blocker (CCB) toxicity usually present with bradycardia and hypotension, but with preserved mental status. This can help differential from Beta Blocker (BB) toxicity, where the patients often have altered mental status.
  • Hyperglycemia is the other hallmark of CCB toxicity, which can help you differentiate from BB. This hyperglycemia may be a harbinger of impending circulatory collapse, so be on guard in a pt with CCB overdose, normal vitals and hyperglycemia
  • Don’t be afraid to use and infuse hyperinsulinemia-euglycemia therapy for BB and CCB toxicity. Have a frank and open conversation with your team about how it works to get everyone on board before your start.
  • TCA overdoses present with a a number of signs and symptoms including anticholinergic symptoms, AMS, hypotension and seizures. Once you identify the TCA toxicity, you’re going to start with fluids and pressors and then move on the antidote which is sodium bicarbonate 1-2 mEq/kg as a bolus followed by a drip. You want to keep pushing sodium bicarb until you see the QRS narrow"

lunes, 7 de enero de 2019

Heparin for ACS

Back Home
First 10EM - By Justin Morgenstern - January 07, 2019
heparin in ACS
"I covered heparin for ACS in one of my earliest blog posts. In light of the study reviewed in the last post, I thought it was time for an update. What follows is a review of the evidence looking at heparin in the management of acute coronary syndromes. Despite its widespread use, I think you will find that the evidence does not strongly support the use of heparin, or actually suggests that heparin is harmful (which is my conclusion)..."

Asthma Exacerbation

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emDocs - January 07, 2019 - Authors: Rodrigues A., Gernsheimer J., Waseem M
Edited by: Koyfman A and Long B
"Take Home Points
  • First: “An ounce of prevention is worth a pound of cure” as Benjamin Franklin once stated. It is important to consider the possible underlying causes of asthma exacerbations, and correct them in order to prevent them in the future.
  • Second: Educate your patients about triggers, both common and sneaky. Encourage handwashing, yearly flu vaccine, weight loss, proper use of medications, and additional long-term evaluation and follow up with pulmonologists. We may be able to reduce suffering, morbidity and mortality in our asthma patients by briefly reviewing triggers with them, both common and sneaky, and strongly encouraging them to get rid of these triggers as much as possible.
  • Third: If you don’t have the evidence to support that an episode of shortness of breath is an asthma exacerbation, then widen your differential and consider other causes."

Stress Ulcer Prophylaxis

R.E.B.E.L.EM - Januar7 07, 2019 - By Lakshmi N. Saladi 
"Author’s Conclusion:
Among adult patients in the ICU who were at risk for gastrointestinal bleeding, mortality at 90 days and the number of clinically important events were similar in those assigned to pantoprazole and those assigned to placebo
Clinical Take Home Point:
Though no proven mortality benefit, the reduced incidence of clinically significant GI bleed without increase in infectious and cardiovascular adverse effects suggests a potential benefit of pantoprazole in selected critically ill patients with multiple risk factors for GI bleed"

domingo, 6 de enero de 2019

Journal Feed (emDocs)

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emDocs - January 05, 2019 - By Clay Smith

2018 AHA Focused Update

The PharmERToxGuy - January 04, 2019 - By Mike O´Brien
"The year 2005 was full of milestones, YouTube was founded in February and it was also the last time lidocaine was included in the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Adult Cardiac Arrest Algorithm. Since 2010, we have been directed by the guidelines to utilize amiodarone as the sole first-line antidysrhythmic. At the same time, there has been an increased focus on early defibrillation and proper CPR technique as opposed to medication administration. In 2015, the International Liaison Committee on Resuscitation (ILCOR) moved away from publishing guideline updates every 5 years to a continuous process wherein they provide updates as the literature dictates..."

Heparin for ACS?

EMLoN Logo
Emergency Medicine of Note - January 2, 2018 - By Ryan Radecki
"We’ve been routinely starting anticoagulation therapy on patients diagnosed with an acute coronary syndrome for a couple decades. The evidence from the preceding era is clear – patients treated with anticoagulation plus aspirin are at much lower risk for subsequent ischemic events than those treated with aspirin alone.
However, these trials are not generalizable to most modern care for ACS. For example, the FRISC and ATACS trial discharged patients with nSTEMI or unstable angina with continued anticoagulation for weeks to months. Revascularization procedures were performed only as rescue therapy, rather than the routine early invasive strategies in use today. Dual anti-platelet and other adjunctive therapies were unavailable. So – do we actually still need the heparin?
These authors retrospectively evaluated the association between parenteral anticoagulation therapy and in-hospital death and in-hospital major bleeding. There were 6,804 patients included in their 4-year, multi-center data set, about two-thirds of whom did not receive parenteral anticoagulation prior to PCI. There were small, probably unimportant differences reported between groups, excepting one feature: time to intervention. Time to intervention was a median of 1 day in those managed without anticoagulation versus a median of 3 days in those managed with. Overall, there was no difference in in-hospital death, nor 30-day, 1-year, or 3-year death for those included in long-term follow-up. A handful of cases suffered bleeding complications, with a small absolute excess in those managed with anticoagulation.
This is neither prospective nor a randomized trial, and there could certainly be unexamined confounding baseline characteristics favoring one treatment group over the other. The authors also note bleeding complications could be ameliorated by use of fondaparinux rather than heparinoids, but this would still be moot if there is still no benefit to anticoagulation. Finally, in-hospital mortality is a fabulous patient-oriented endpoint, but it does not tell the entire story with regard to any additional morbidity potentially resulting from anticoagulation being withheld. We should not change practice based on this level of evidence, but these data should prompt further examination and potentially prospective evaluation.
“Association of Parenteral Anticoagulation Therapy With Outcomes in Chinese Patients Undergoing Percutaneous Coronary Intervention for Non–ST-Segment Elevation Acute Coronary Syndrome”

jueves, 3 de enero de 2019

Acute Kidney Injury

PulmCrit (EM Crit)
PulmCrit (EM Crit) - January 2, 2019 - By Josh Farkas
"The importance of avoiding and treating renal failure cannot be overstated. The kidneys are delicate organs, often the first to be injured by systemic hypoperfusion or other insults. Severe renal dysfunction leads to a cascade of badness, promoting the failure of other organs and eventual spiraling into multi-organ failure.1 Alternatively, if we are can defend a patient's renal function and avoid volume overload, then we will probably improve their prognosis substantially."
The IBCC chapter is located here


The Podcast Episode

EM Cases top 10 2018

EM Cases Best of 2018
Emergency Medicine Cases - By Anton Helman
..."Based on a blend of the number of podcast downloads, webpage views, social media engagement, number of positive emails and comments that I received, and my own favs, I’m pleased to bring you the EM Cases Best of 2018 Top 10. Many huge thanks to the entire EM Cases team, Advisory Board, SREMI, the amazing guest experts and you, the listeners of the podcasts, readers of the blogs, viewers of the videos and participants in the course, for making 2018 another successful year for EM Cases!.."

E
M Cases Best of 2018 Top 10
#10 Episode 111 Effective Learning Strategies in EM with Jonathan Sherbino & Rick Penciner Link
#9 Episode 118 Trauma – The 1st & Last 15 Minutes with Kylie Bosman, Chris Hicks & Andrew Petrosoniak Link
#8 Best Case Ever 68 Ectopic Pregnancy Pitfalls in Diagnosis With Catherine Varner Link
#7 Episode 113/114 Pulmonary Embolism Diagnosis & Workup with Eddy Lang & Kerstin DeWit Link, Link
#6 CritCases 9 Pre-eclampsia & Preterm Labour with Sean Moore, Michael Misch & Glenn Posner Link
#5 Episode 109 Skin & Soft Tissue Infections with Melanie Baimel & Andrew Morris Link
#4 POCUS Cases 3 Idiopathic Intracranial Hypertension with Rob Simard Link
#3 Journal Jam 12 BNP for Acute CHF with Justin Morgenstern, Rory Spiegel & Brian Steinhart Link
#2 Best Case Ever 72 Overinvestigation in EM with Shabhaz Syed Link
#1 Episode 112 Tachydysrhythmias with Amal Mattu & Paul Dorion Link

Trauma papers

MEDEST - January 03, 2019 
"Third step of 1 YEAR IN REVIEW, the classical end of year MEDEST appointment with all that matter in emergency medicine literature.
In this post we review the 2018 Trauma papers divided by topic.
So let’s start..."

UTI in Elderly

REBEL EM - Emergency Medicine Blog
R.E.B.E.L.EM - January 03, 2019 - By Rick Pescatore
"Conclusion
No current rigorous trial has yet examined procalcitonin’s performance in this narrow and nuanced framework, but the collated and considered information available to use suggests that adding this simple test may provide a much-needed diagnostic beacon and potentially lead to better care in real-world applications."

miércoles, 2 de enero de 2019

Top Stories of 2018

NEJM Journal Watch  - Daniel J. Pallin
"A perspective on the most important research in the field from the past year
Dear Readers,
This year has been marked by the insanity of the opioid epidemic, but there have been significant advances on less sensational topics. A much more nuanced approach to care of patients with pulmonary embolism has emerged, with selective anticoagulation, outpatient management, and improved use of the d-dimer assay. We continue to hone our approach to neuroimaging, as research identifies more and more patients who don't require these expensive scans. We end our top-10 list with some very surprising practice-changing research on magnesium and ondansetron..."

Best of 2018 on PulmCCM

PulmCCM
PulmCCM - January 01, 2019

Trauma – The First and Last 15 Minutes

Emergency Medicine Cases Logo
Ep 119 Trauma – Emergency Medicine Cases - Podcast production, sound design & editing by Anton Helman, Voice editing by Suchetta Sinha.
Written Summary and blog post by Anton Helman January, 2019
Trauma First and Last 15 minutes Part 2
"In this podcast we answer questions such as: What should your resuscitation targets be in the first 15 minutes for trauma patients with hemorrhagic shock, spinal shock, severe head injury? When is a pelvic binder indicated? Is a bedsheet good enough? What are the most common pitfalls in binding the pelvis? What are the best ways to maintain team situational awareness during a trauma resuscitation? Should we rethink patient positioning for the trauma patient? What are the indications for transport to a trauma center? What is the minimal data set required before transfer? Which patients require a pelvic x-ray prior to transfer to a trauma center? What are the key elements of a transport checklist? What does the future hold for trauma care and many more…"

Trauma laparotomies

ST.EMLYN'S - By Richard Carden - December 28, 2018
"Mortality for hypotensive trauma patients undergoing emergency laparotomy have not changed in 20 years. This blog explores the literature and the future!"

Best articles of 2018

jf-logo-2.PNG
Journal Feed - December 31, 2018

JournalFeed

martes, 1 de enero de 2019

Top emDocs Posts of 2018

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emDocs- December 31, 2018 - Authors: Long B, Singh M and Koyfman A
"Thank you to our readers and our amazing contributing authors this past year! You and your amazing support always keep us going and motivate us to continue providing great content. 2018 saw the further development of several great emDocs series and the addition of Pain Profiles by Dr. David Cisewski and artwork from Dr. Katy Hanson, and 2019 holds even greater promise. Happy Holidays and Happy New Year!
Now, without further ado, here is our list of our top posts from 2018 based on viewership from you the readers..."

ABCs (score)

TAMING THE SRU - December 31, 2019 - By  Colleen Laurence
"We are now approaching 10 years since Nunez and colleagues first shared the ABC Score. In the seeming flood of comparative studies that followed, the ABC Score has been variable in its predictive value, never performing quite as well as it did in Nunez and Cotton’s studies. It is only right then that it continues to be reassessed as new scores are validated and point-of-care testing evolves. Ultimately though, there the American College of Surgeons continues to recommend its adoption above other tools to trigger MTP. Why?
The ABC Score is easy to remember and to use – four simple variables without weights attached. 
The ABC Score does not rely on time-consuming tests. In general, scores that incorporate more sophisticated variables and weighting unsurprisingly demonstrated superior predictive value compared to the ABC Score. However, they relied on laboratory or radiographic analysis, which could critically delay transfusion. 
Finally, while the ABC Score overestimates the need for massive transfusion, it also consistently identifies those patients who will require a massive transfusion. It is important to remember that these scores are not predicting who will need transfusion, only who will need the additional resources of Massive Transfusion. Ultimately over-triaging is an unfortunate, but acceptable consequence in exchange for a patient who can be appropriately resuscitated and survive."

2018 thoughts and reflections

St. Emlyn´s - By Simon Carley - January 1, 2019
"As 2018 comes to an end we asked the St Emlyn’s team to reflect on the highs and lows of a fascinating year. The brief was pretty vague as we wanted the team to think fairly broadly and to give a broad range of answers..."

domingo, 30 de diciembre de 2018

Pericarditis

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emDocs EM@3AM - December 29, 2018 - Author: DeYoung H, Sulava E
Edited by: Long B
"Pericarditis is inflammation of the pericardial sac that surrounds the heart. This may be a result of infection, most commonly by a virus, however, bacteria and fungi have also been reported. Other etiologies include malignancy, drugs, uremia, or postmyocardial infarction. Pericarditis may also be idiopathic, which is thought to represent most cases. The patient typically presents with sudden or gradual chest pain that they describe as sharp or stabbing. Frequently, there is radiation to the back, neck, or left shoulder or arm. The pain may be worsened by movement or inspiration and will classically improve with sitting up and leaning forward and be made more severe by lying supine. Associated symptoms may include fevers, dyspnea, or dysphagia. A recent viral infection may also be reported. Physical exam may reveal a friction rub that is best heard at the left lower sternal border or apex. ECG findings of acute pericarditis consist of diffuse ST elevation that appears more convex in most leads. Rarely are there reciprocal changes. There is also PR segment depression. These changes are transient and therefore patients may have pericarditis without ECG changes. The diagnosis of acute pericarditis is made by the presence of two or more of the following: sharp and pleuritic chest pain, pericardial friction rub, ECG findings consistent with pericarditis, and new or worsening pericardial effusion. Additional lab tests and imaging is directed toward determining an etiology if concerns are present for causes other than idiopathic or viral pericarditis. Treatment for acute pericarditis can be outpatient, if the etiology is presumed to be viral or idiopathic and the patient is hemodynamically stable, with nonsteroidal anti-inflammatory drugs and follow-up. If other etiologies are present, then treatment will be specific to those causes and may require admission. Any patient with myocarditis, uremic pericarditis, enlarged pericardial silhouette on chest X-ray, or hemodynamic compromise requires admission."

viernes, 28 de diciembre de 2018

Spinal Stabilisation

SCANCRIT - December 7, 2018 - By Thomas D
"There’s been a lot of debate and controversy over spinal stabilisation in traume the last couple of years. Per Kristian Hyldmo is a HEMS anaesthetist, has done a PhD focusing on transportation of trauma patients including the lateral trauma position, and engaged in spinal stabilisation. He is part of the national Norwegian taskforce that published the Norwegian guidelines for spinal stabilisation in trauma two years ago. This formalised the move away from cervical collars in trauma, that had started a few years earlier.
Watch Hyldmo’s take on spinal stabilisation in 2018 in this presentation from TBS18:

 

Peritonsillar Abscess

Resultado de imagen de emergency medicine news
Emergency Medicine News 2018; 40: (12): 8-9
doi: 10.1097/01.EEM.0000550365.44330.de
"A patient with an infection or a collection of pus in the peritonsillar area is rather common in the ED. The process can be cellulitis or a distinct peritonsillar abscess (PTA), also called a quinsy. The infection is characterized by severe sore throat, painful swallowing, fever, drooling, tender adenopathy, muffled voice, and sometimes trismus.
It may be clinically difficult to differentiate between cellulitis and abscess initially. (“Distinguishing Peritonsillar Abscess from Cellulitis,” 2018;40[11]:12; http://bit.ly/EMN-InFocus.) The treatment for an abscess consists of draining the pus, which can be done by needle aspiration or incision and drainage (I&D). Both interventions can be performed in the ED, but most emergency clinicians prefer to do only a needle aspiration. A formal I&D is eschewed because it is somewhat complex and more difficult. Cellulitis is treated with antibiotics, but may progress to an abscess.
The medical literature has compared clinical results from aspiration with I&D for the past 30 years, and numerous articles have attempted to determine the preferred method. The most recent comparison appeared in the Cochrane Database of Systematic Reviews to attempt, unsuccessfully, to assess the effectiveness of one compared with the other intervention..."

Magnesium

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ACEP Now - By Jeremy Samuel Faust and Lauren Westafer - December 17, 2018
FOAMcast
"Fads come and go. However, in the world of free open access medical education (#FOAMed), some favorite topics have stood the test of time. For example, FOAMed loves to talk about ketamine, managing the difficult airway, and, for some reason, magnesium. People seem to love the idea that magnesium, a humble group 2 alkaline Earth metal, might possibly be an effective treatment for so many different medical conditions..."

Community-acquired urosepsis

PulmCrit (EMCrit)
IBCC chapter & cast - December 26, 2018 - By Josh Farkas
"Urosepsis is one of my favorite ICU diagnoses. In almost all cases, patients will improve dramatically within 12-24 hours and leave the ICU with minimal sequelae. But that shouldn't lull us into a false sense of security: careful antibiotic selection, aggressive resuscitation, and (in some cases) emergent drainage may be required for a good outcome."

The IBCC chapter is located here.

Airway management

MEDEST - December 27, 2018
"Second step of 1 YEAR IN REVIEW, the classical end of year MEDEST appointment with all that matter in emergency medicine literature.
In this post we review the 2018 Airway management literature of note divided by topic.
So let’s start..."

miércoles, 19 de diciembre de 2018

Trauma (First and Last 15 Min)

Emergency Medicine Cases Logo
Emergency Medicine Cases - By Hanton Helman


"Take Home Points for Trauma – The First and Last 15 Minutes Part 1
  • Prepare your team, your gear and yourself prior to patient arrival with 4 discussion points, assigning specific gear preparation to specific team members and mental preparation
  • Resequence the trauma resuscitation by managing massive external hemorrhage and active/dynamic airway first, then concentrating on hemodynamic optimization before definitive airway management in those patients without active/dynamic airways
  • Identify occult shock using shock index >1, delta shock index ≥0.1, the lowest BP recorded, FAST/IVC, a fluid challenge and clinical exam
  • Consider the patient’s age, blood pressure medications and baseline blood pressure in assessing for occult shock, interpreting the shock index and in deciding to activate massive transfusion protocol
  • Early actions to consider include control of massive external hemorrhage, bilateral finger thoracostomies, pelvic binder, tranexamic acid, activation of massive transfusion protocol and call for help
  • Two large bore IVs are the preferred initial access in most trauma patients
  • Avoid transferring a patient long distances with IO access only
  • Large volumes of crystalloid may lead to the “triangle of death”; your goal should be no crystalloid
  • Controlled resuscitation to a target SBP of ≥70 is reasonable in most young, otherwise healthy trauma patients presumed to be in hemorrhagic shock
  • Use clinical judgement, mechanism of injury, pitfall conditions, shock index and resuscitation intensity to help in decisions to activate massive transfusion protocol"

martes, 18 de diciembre de 2018

COPD Exacerbation

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emDocs - December 17, 2018 - Authors: Sarah Iosifescu and Jennifer Beck-Esmay
Edited by: Alex Koyfman and Brit Long
"Key Points
  • Do not assume that all patients with COPD that present with dyspnea have a clear-cut infectious or medicine non-compliant COPD exacerbation. Keep a lookout for abnormal lab results or lack of responsiveness to standard treatment in COPD exacerbations in case there are other underlying causes.
  • There is mixed data on PE as a trigger for a COPD exacerbation, but the evidence so far suggests it may be real. It doesn’t mean that you need to evaluate every COPD patient for PE with CT, but it should be on your mind.
  • COPD patients are more sensitive to environmental and weather triggers and are more likely to have exacerbations in cold weather and when exposed to higher air concentration of pollutants.
  • Non-selective beta blockers can decrease lung function in COPD patients; use beta blockers with caution in COPD patients.
  • Infections are likely the most common cause of COPD exacerbation, with bacteria the most common species. Antibiotics are associated with improved outcomes, especially in severe exacerbations."