Back From Vacation - Blog Updates from Recent Topics Week of Aug 1 - 5

Aug 3rd - Evaluation of Cognitive Impairment / Acute Delirium

Hallmark of delirium is fluctuating course with impaired concentration.  My favorite mnemonic to remember causes is I WATCH DEATH, as it also helps remind me what an ominous condition this is.

This site from Vandy has a rundown of that as well as other mnemonics to help with delirium.

Aug 4th - Resuscitation from Lower GI Bleeds.

Sometimes catastrophic bleeding, but usually less immediately life threatening than upper GI bleeds.  Just remember the mantra "two large bore peripheral IVs" when approaching the resiscitation of any hemorrhage.

As far as transfusion triggers goes, generally a lower threshold hemoglobin is better.  There is also some data from Europe that transfusions increase rebleeding risk, at least in upper GI hemorrhages.  Waiting for the hemoglobin to drop ~7 is probably best, barring signs of impaired oxygen delivery.  There is no convincing evidence that transfusing those with cardiac disease up to hemoglobins of 10 is helpdful, and in fact may be harmful.

Aug 5th - End of Life Care

Not directly related to case discussed, but wanted to share this recent JAMA article on elder abuse and self neglect.  Complex situation without good solutions in may cases.