Internal med flashcards: pulmonary and critical care

Internal Medicine Board Review - Pulmonary Flashcards - by Knowmedge from Knowmedge

The Epley maneuver in benign positional vertigo

The Epley maneuver is supported by high level evidence according to this review.

The full text of the review provides links to videos of the Dix-Hallpike test (a diagnostic maneuver) and the Epley maneuver itself.

Anti-vertigo medications, despite their popularity and anecdotal evidence that suggests they work, are not supported by high level evidence according to the review.

Use of epinephrine in anaphylaxis

What route?

Eosinophilic asthma

---as a distinct phenotype. Free full text review.

Internal med flashcards: rheumatology

Internal Medicine Board Review - Rheumatology Flashcards - by Knowmedge from Knowmedge

Electrical storm

Review of clinical presentations and management.

Brief ECMO review

From Mayo's EMBlog.

Spontaneous coronary artery dissection: an emerging entity

A free full text review was recently published in Mayo Clinic Proceedings. From the paper:

Spontaneous coronary artery dissection (SCAD) is an important cause of acute coronary syndrome and sudden death in young persons, particularly women. Associated conditions include fibromuscular dysplasia, peripartum status, and episodes of extreme emotion or exercise. Because of heightened awareness and improved diagnostic accuracy, it is increasingly important for clinicians to understand SCAD. Moreover, short-term and long-term management strategies diverge from typical strategies for atherosclerotic disease.

Echocardiographic IVC characteristics and heart failure compensation

From a recent study:

Aim

The purpose of this study is to evaluate the utility of IVC diameter, using echocardiography as a marker of volume overload and the relationship between these parameters and N-terminal pro-B natriuretic peptide (NT-proBNP) in patients with systolic heart failure (HF).

Methods

We included 136 consecutive patients with systolic HF (left ventricular ejection fraction, less than 50%), including 80 patients with acutely decompensated HF and 56 patients with compensated HF as well as 50 subjects without a diagnosis of HF. All patients underwent transthoracic echocardiography to assess both their IVC diameters and the degree of inspiratory collapse (greater than or equal to 50%, less than 50%, and no change [absence] groups); NT-proBNP levels were measured, and these data were compared between the 2 groups.

Results

Inferior vena cava diameter and NT-proBNP were significantly higher among the patients with HF than among the control subjects (21.7 ± 2.6 vs 14.5 ± 1.6 mm, P less than .001 and 4789 [330-35000] vs 171 [21-476], P less thatn .001). The mean IVC diameter was higher among the patients with decompensated HF than among the patients with compensated HF (23.2 ± 2.1 vs 19.7 ± 1.9 mm, P less than .001). The values of NT-proBNP were associated with different collapsibility of IVC subgroups among HF patients. The NT-proBNP levels were 2760 (330-27336), 5400 (665-27210), and 16806 (1786-35000), regarding the collapsibility of the IVC subgroups: greater than or equal to 50%, less than 50%, and absence groups, P less than .001, respectively, among HF patients. There was a significant positive correlation between IVC diameter and NT-proBNP (r = 0.884, P less than .001). A cut off value of an IVC diameter greater than or equal to 20.5 mm predicted a diagnosis of compensated HF with a sensitivity of 90% and a specificity of 73%.

Conclusions

Inferior vena cava diameter correlated significantly with NT-proBNP in patients with HF. Inferior vena cava diameter may be a useful variable in determining a patient's volume status in the setting of HF..

What's interesting here is that these echocardiographic parameters are nothing more than surrogates for CVP measurements, which have, deservedly or not, fallen into disfavor in evaluating patients with shock. Nevertheless it seems to perform well in the setting of heart failure.

Endobronchial ultrasound

Free full text review.

Can the impact and educational value of medical social media be measured?

Here is one proposal.

Early repolarization syndrome

This free full text review discusses the relevant electrophysiology and how to distinguish benign early repolarization (BER) from the more malignant early repolarization syndrome (EPS).

Drug induced pancreatitis

Free full text review here.

Unreliability of the STEMI vs NSTEMI distinction

This is just a case report but it illustrates the growing awareness of this problem. The authors conclude:

ST-segment elevation only may not always reflect ongoing ischaemia and we should no longer focus on the presence or absence of ST-segment elevation as a reliable criteria to proceed or to postpone urgent angiography and/or reperfusion therapy [1, 2]. Future studies should focus on the NSTEMI ACS algorithm and its identification of high-risk patients who may benefit from urgent coronary angiography and subsequent revascularisation [3, 4, 5]. In our opinion, the acute myocardial infarction classification based on ST elevation alone should be reconsidered.

Glycemic targets for DM type 2

Here is a nuanced view that is worth the read in its entirety.

What's the optimal diuretic strategy in acute decompensated heart failure? It's complicated.

No clear answers emerged in this review.

Transfusion in critical illness

Blood Transfusion in ICU from Sherif Badrawy

Depression and autoimmune diseases

Is there a link?

Fascinating ECG tracings

Ecg intensive from Andey Rahman

IV TPA for acute ischemic stroke

Here's a summary of clinical trials with a focus on time to treatment. Free full text.