Hospital Medicine Quick Hits

Machines better for CPR

dscheurer — Sun, 19 May 2013 01:53:06 +0000

This meta-analysis of 12 studies of out-of-hospital cardiac arrest found that machine-delivered CPR was associated with ~1.5 times the odds of return of spontaneous circulation compared to human CPR. This may also be true for in-hospital arrest but needs further … Continue reading →

Continue warfarin for pacer/ICD procedures

dscheurer — Sun, 12 May 2013 02:07:20 +0000

In this trial of patients on warfarin undergoing a pacer/ICD procedure, they were randomized to continue warfarin perioperatively, or receive heparin bridge therapy. The study was stopped early when the heparin group suffered 4 times more device pocket hematomas than the warfarin group. Based on this well done trial, warfarin should be continued perioperatively in patients undergoing pacers/ICDs (abstract).

Copper reduces hospital acquired infections

dscheurer — Sun, 12 May 2013 02:01:36 +0000

The use of copper on high-touch ICU surfaces significantly reduces the risk of hospital acquired infections and MRSA/VRE colonization (abstract).

Guidelines for the management of ascites

dscheurer — Sun, 12 May 2013 01:57:47 +0000

The American Association for the Study of Liver Disease has released guidelines on the management of ascites. Among the recommendations, some include: use caution when prescribing agents that lower arterial blood pressure (such as ACE/ARBs), avoid the vaptan drugs, and use quinolines to prevent SBP only when necessary (to avoid resistant organisms). The full guidelines can be found here (guidelines).

SSRIs associated with higher perioperative risks

dscheurer — Sun, 05 May 2013 01:32:21 +0000

This large propensity matched study found perioperative SSRIs were associated with higher in-hospital mortality, bleeding, and 30 day readmission rates compared to those not on SSRIs. More data is needed to determine if the association is due to the SSRI itself, and if so, if perioperative suspension of SSRIs is warranted (abstract).

FDA approves prothrombin concentrate

dscheurer — Sun, 05 May 2013 01:23:14 +0000

The FDA just approved a prothrombin complex concentrate (Kcentra) to reversal bleeding associated with vitamin K antagonists. It does not require thawing or blood type matching, unlike plasma, but it does carry a black box warning for risk of clotting (arterial and venous) (FDA site).

Penicillin for cellulitis prophylaxis

dscheurer — Sun, 05 May 2013 01:13:09 +0000

The large trial recruited patients with 2 or more recurrent bouts of leg cellulitis and randomized them to 12 months of penicillin (250mg BID) or placebo. Recurrence was lower in the penicillin group (22% vs 37%), with no difference in … Continue reading →

Medicaid benefits?

dscheurer — Sun, 05 May 2013 01:01:42 +0000

This study in Oregon compared 2 year results of those that were enrolled in Medicaid or not, based on a random lottery system. There were no difference between the groups in outcomes of chronic conditions, such as high cholesterol or HTN, but those with Medicaid were more likely to be diagnosed and treated for diabetes, were less likely to report depression, were more likely to have received preventive services, and were less likely to have catastrophic out-of-pocket expenses. There are some tangible benefits of gaining Medicaid coverage, but some of the effects may not be seen within 2 years (abstract).

H7N9 cases in China

dscheurer — Sun, 05 May 2013 00:48:14 +0000

China has now reported 126 human cases of H7N9 influenza, including 24 deaths. Almost all cases had severe respiratory illnesses requiring hospitalization. No cases have been seen in the US, and the CDC is actively working on a vaccine (CDC … Continue reading →

CABG vs PCI: depends on the patient

dscheurer — Sat, 27 Apr 2013 23:40:02 +0000

This large randomized trial found lower mortality with CABG (vs PCI) in patients with diabetes, heart failure, peripheral arterial disease, or tobacco use; but those with none of these risk factors had lower mortality with PCI (abstract).