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Small subcortical brain infarcts, known as lacunar strokes, account for about 25% of all ischemic strokes.
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A historical cohort study from San Francisco General Hospital evaluated patients ≥18 years old that were hospitalized and received at least one dose of ceftriaxone. In a multivariable analysis, for every day a patient also received doxycycline the rate of Clostridium difficile infection was 27% lower than for those who did not receive doxycycline (hazard ratio, 0.73%; 95% confidence interval, 0.56-0.96).
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Pediatric stroke remains one of the top 10 causes of death in children, with a mortality rate of 0.6 deaths per 100,000 strokes, and almost all of those affected have a residual neurologic deficit.
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Managing chronic pain is a challenge for patients and clinicians alike, with 52% of chronic pain patients being treated solely by their primary care physician.1 Chronic myofascial pain affects 116 million American adults, which is more than heart disease, cancer, and diabetes combined.2
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My mother was on warfarin for a number of years and her degree of anticoagulation was difficult to manage. She had a number of complications, including bleeding episodes. So, I was enthusiastic about these new anticoagulants with their more predictable therapeutic effect. As with all new drugs, there are downsides; currently the lack of a readily available coagulation test to assess if there is a significant coagulopathy and an effective reversal agent. As these drugs are increasingly used, emergency physicians will see patients such as the three cases presented below.
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