So today I surveyed some of the medical blogs for recent interesting posts and these (in no particular order) caught my eye:
Retired Doc comments about Joint Commission’s recent decision to change the four hour antibiotic rule for pneumonia treatment to six hours. They just don’t get it. (The updated and recently published guidelines promulgated jointly by the ATS and the IDSA have eliminated all specific timing recommendations for the administration of initial antibiotic doses, citing the potential for abuse of antibiotics and flaws in the evidence upon which the original four hour rule was based. “Guideline concordant therapy” for community acquired pneumonia should include the administration of antibiotics as soon as possible, and in most cases in the ER, but no longer incorporates rigid time rules).
DB cites a clinical vignette from the New York Times presented by columnist and Yale internist Lisa Sanders, M.D. The patient, who presented to the ER with abdominal pain, hypotension and profound bradycardia was ultimately “cured” by the urology resident. The sequence of events was that this patient, despite a lack of prior urinary symptoms, was in acute urinary retention which led to renal failure, hyperkalemia and, consequently, depression of cardiac function. The case is instructional and interesting on several levels. Could application of the Prostate Symptom Score have averted the crisis? Although it’s an intriguiging question, Dr. Sanders’s self flagellation seems unwarranted.
The Patient’s Doctor has a couple of items concerning Wal-Mart, headquartered just down the street from where I sit. The Washington Post reports Wal-Mart’s plan to open 400 in-store clinics. IHealthBeat reports on remarks by Wal-Mart’s CEO on the role of business in transforming U.S. healthcare.
The Dinosaur presented a case puzzler here, and the solution here. One commenter was partially correct and everyone else missed it a mile. The patient had an uncommon presentation of a common disease (peptic ulcer). The lesson? Perhaps it’s the old saw (that I think I remember once reading in Cliff Meador’s Little Book of Doctors’ Rules) that you can not diagnose that which is not in your differential diagnosis, assuming you generated one in the first place. Or maybe that it’s occasionally appropriate to order an imaging study without a focused clinical question, other than just to “see what’s going on.”
For a little gallows humor here are some politically incorrect mnemonics being kicked around at the Student Doctor Forum (via Kevin).
The blogosphere was screaming after the U.S. Supreme Court decision to uphold the Partial-Birth Abortion Ban Act of 2003, even calling it shameful and incomprehensible, apparently so incomprehensible that no medical blogs I could find provided a link to the original document. For those interested and who think they can comprehend the nuances, it’s here.