Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
What is current best practice with regards to antibacterial prophylaxis in patients with hematologic malignancy and resolved neutropenic fever (>72 hours)?
For patients with febrile neutropenia, recent literature has demonstrated that early de-escalation and discontinuation of antibiotics may be safe for some patients. Since ECIL guidelines have recommended modification of the initial regimen at 72-96 hours based on the patient's clinical course and mi...
Would you recommend hospitalization for surgery for a large papillary fibroelastoma or atrial myxoma discovered on an outpatient echocardiogram?
NOT necessarily to hospitalize if incidental finding given that both of these lesions are typically present for years prior to diagnosis (unless of course you are concerned about getting sued if a bad outcome occurs). If these lesions are found in the context of a recent neurological syndrome then c...
Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?
While long-term GH replacement in GHD individuals increased BMD (after an initial decline at 6 months point), I am not aware of any placebo-controlled study that convincingly showed an effect on fractures.
Does TpA or TNK cause acute post infusion severe headache with no intracranial bleed?
The short answer is yes patients can develop headaches post thrombolysis. Some report about 32-33% of AIS patients post thrombolysis experience headaches without hemorrhagic conversion. These do not seem to be associated with the increasing risk of hemorrhagic conversion. Some stroke patients develo...
What is the best approach in management of device related thrombus seen immediately after watchman deployment?
Continue ASA and Eliquis for several weeks and then recheck.
How long do oscillopsia and ataxia secondary to thiamine deficiency last after completing repletion?
I treated a patient with severe thiamine deficiency following bariatric surgery. I administered parenteral thiamine at a dose of 100 mg weekly. The diplopia resolved with the first infusion, but returned 5-6 days. She was continued on thiamine infusions weekly and her diplopia eventually resolved. I...
How long should surgery be delayed in a patient with localized, resectable pancreatic cancer who developed acute pancreatitis following EUS guided biopsy?
This is a great question, and the answer is yes, it should be delayed to avoid surgical complications, healing, etc. In such scenarios, surgery might be delayed up to 2 months or longer even, depending on the time to recovery. In our practice, we employ a neoadjuvant approach for these patients and ...
Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?
The strict answer to this question, including "all patients hospitalized with acute MI" is no based on the results of the recently reported EMPACT-MI trial. In this study of more than 6000 patients empagliflozin did not significantly improve a composite endpoint of hospitalization for heart failure ...
Do you ever employ the use of prolonged periods of pressure support ventilation as means of "weaning" in the management of patients with acute respiratory failure?
The evidence basis here would suggest no one mode is superior for weaning vs just putting patients on SBT. However, as a practical matter, weaning a patient from the ventilator involves letting sedatives metabolize/wear off (propofol can take days to wash out after a week of use), and testing how th...
How do you approach the management of capmatinib induced edema?
I don't know that I can give a comprehensive approach to the edema associated with capmatinib, but I can give a couple of observations that I think may help practitioners. Dose reduction can help if other measures don't accomplish what is wanted. I have several patients in their late 80s and early 9...