August 29 WeeklyUpdate

Not as much content this week due to quiz bowl and ethics case rounds, but the following articles are very good reading:

From Monday's noon conference on endocarditis, I recommend this condensed article from NEJM that covers what you need to know about endocarditis for board purposes.

Friday morning report covered management of acute ischemic stroke, as well as measures to prevent recurrences.  Good articles covering the topic are below:

Acute Ischemic Stroke (NEJM Clinical Practice)

Secondary Prevention After Ischemic Stroke (NEJM Clinical Practice)

On a related note, the question often arises - should we heparin bridge A-fib patients on warfarin therapy when their medication is held for surgical procedures.  The answer, according to a study in this week's NEJM, is no.  Stroke events are not reduced, and bleeding is increased if heparin is used during the time warfarin is held.  Always pay attention to exclusion criteria, as this trial excluded anyone who had experienced stroke or TIA symptoms within 12 weeks.

Resuscitated

After a long hiatus, the IM blog is back in action.  I will make weekly posts with links for additional reading to follow up discussions form conferences.

On the topic of resuscitation:  The AHA has specific guidelines for resuscitation in certain unique situations, such as severe asthma, pregnancy, etc.  I will develop a simulation center scenario for one of these for use in a future SimMan session.  The material in this article goes far beyond the material covered in standard ACLS provider courses, and should be reviewed before taking on code team leader responsibilities.  There are separate articles that describe ACLS in the setting of recent cardiac surgery.  These are not currently part of official AHA ACLS guidelines but have been adopted by some institutions.

On the topic of appropriate use of the thrombophilia panel - the BJH has a nice summary of the topic.  In general, these workups are most appropriate for the outpatient follow up setting in select cases only.  Their utility in guiding the inpatient management of most patients is questionable.