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B-type natriuretic peptide (BNP) is a biomarker released by cardiac ventricular myocytes. Its usefulness is mainly in the emergency room for the evaluation of acute dyspnea, to evaluate for cardiac failure. BNP may have usefulness as a screening test for preclinical heart disease, for risk stratification and for guidance with therapy.
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Although regular aspirin use reduces the risk for colorectal adenoma formation as shown in previous randomized-controlled trials, the protective effect now seems to be greatest at substantially higher doses (> 14 standard tablets/week) than currently recommended for cardiovascular prophylaxis.
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The FDA has approved a combination product of amlodipine and atrovastatin for the treatment of patients with comorbid hypertension and hypercholesterolemia.
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The ECG shown in the Figure was obtained in the emergency department (ED) from a 61-year-old woman with a history of significant hypertension. She was alert, oriented, and not in acute distress at the time this tracing was recorded, although she was markedly hypertensive and experiencing some chest pain. No prior ECG was available. The patient was treated in the ED with several doses of Adenosine and eventually converted to sinus rhythm. Your thoughts on the rhythm and the management?
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The NIH has halted the estrogen-alone wing of the Womens Health Initiative a year before its scheduled end.
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Documentation requirements for every patient encounter have increased, leaving less time for the actual practice of medicine. While documentation is a burden to physicians and nurses, it does have unlimited value. Documentation allows for appropriate billing for the time and efforts of the physician, nurse, and other medical specialists. Thorough documentation allows for maximum reimbursement without fear of subsequent legal retribution from various government programs. Furthermore, the medical record is an essential historical document of the patients previous medical encounters. Documentation of the patient encounter and treatment will provide a defense to potential subsequent litigation that may ensue. The emergency physician may be unaware that a medical expert is reading a case of a previous patient encounter right now. The documentation of the care provided may preclude the plaintiffs expert from making assumptions and opinions adverse to the physician. This months issue will detail the importance of documentation and outline strategies for reducing risk.
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In this randomized, controlled trial, European investigators looked at the role of vasopressin in treating out-of-hospital cardiac arrest. Although the study did not show any benefit of using vasopressin when compared to epinephrine in terms of survival to hospital, this study nonetheless makes a weak argument to use vasopressin in cardiac arrest patients with asystole.
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This article points out the disadvantages of partial DNR ordersfor both clinicians and patientsand offers clear steps for mitigating the problem by developing a supplemental patient care plan for patients who are less than full code.
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Higher patient copays and increasing numbers of people who are working but not insured have made the management of self-pay accounts a more crucial issue than ever for most of the nations hospitals.
