Hospital Medicine Alert – December 1, 2008
December 1, 2008
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Management of Type B Aortic Dissection
Uncomplicated type B aortic dissection (origin distal to left subclavian artery) is usually treated medically. However, early mortality is 10%-12%, and is due to complications.Non-invasive Ventilation in Acute Cardiogenic Pulmonary Edema
In patients with acute cardiogenic pulmonary edema, CPAP or NIV produces a more rapid improvement in respiratory distress and arterial blood gases than standard therapy.IV Thrombolysis 3-4.5 Hours after Stroke: Time for a Change?
Intravenous thrombolysis is safe and effective for the treatment of ischemic stroke in the time window of 3-4.5 hours after the onset of symptoms.A Pathogen to Consider More Broadly in Patients with Pneumonia: Legionella
The incidence of legionellosis in the United States increased significantly in 2003-2005 compared to previous years. This was due mostly to an upsurge of cases in the northeastern and southern United States and a shift of disease from elderly to middle-aged adults. Legionellosis should be considered as a potential cause of pneumonia in a broad range of patients, rather than a small subset with specific risk factors.When is the Best Time to Obtain Blood Cultures from My Potentially Septic Patient?
Many physicians have followed the historical practice of ordering blood cultures to be drawn as close as possible to the time of the peak of the febrile episode (fever spike). In the absence of prescient knowledge of this moment, physicians order blood cultures to be drawn at intervals ranging from 30 minutes to 2 hours. A paper by Jaimes et al suggested that many factors, other than fever, such as shaking chills, WBC counts, hypotension, and more were needed to better predict whether a patient was experiencing bacteremia.