Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
How have you integrated the new HPV self-swab collection into your routine cervical cancer screening, particularly in those with prior abnormal results?
Unfortunately, the new HPV self-swab collection is not currently available in my institution, but I would definitely incorporate this into my routine cervical cancer screening if it were an option! I think the HPV self-swab option is ideal for patients who are either not amenable to a pelvic exam or...
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
When pursuing complex PCI of the RCA (especially when lesion preparation is required), when do you consider placing a transvenous pacemaker in anticipation of conduction abnormalities?
There are a few options when using roto for the RCA or a dominant LCX. Upfront TVP if you want to play it safe. Pretreatment with aminophylline 100-250 mg 10 minutes. Test run without pre-treatment and having atropine and/or TVP nearby at the ready. Which you choose depends on gut instinct and how...
Do you prefer a loading dose of 300mg or 600mg plavix for patients presenting with NSTEMI or unstable angina about to undergo LHC?
Interesting question! As a rule of thumb, 600mg loads faster than 300mg. Therefore, it is more important when you anticipate your ballooning/stenting happening sooner rather than later (within minutes/hours). Per guidelines, Plavix is preferred over prasugrel/brilinta for stable angina (which was no...
What would be your advice to providers who are wary of QTc prolongation after starting an amiodarone load and wish to discontinue it?
Amiodarone has been studied in patients with prior TDP patients and found to be safe (small paper from Mattioni et al., PMID 2774388 at Northwestern at the time of my EP fellowship). Amiodarone has been found to be more effective when it prolongs the QT, and the 500 mS limit does not apply to it as ...
What criteria do you utilize in deciding when to treat or not treat frequent VPC’s?
Symptoms (burden and severity) PVC burden (>15-20% may lead to a cardiomyopathy) Presence of LV dysfunction Interference with bi-ventricular pacing PVCs triggering VT or VF
When would you consider AV nodal ablation in CRT-non-responders with persistent atrial fibrillation?
AV node ablation is the most definitive method for rate control. In this scenario where the patient already has CRT and is a nonresponder, what I do next depends on age of the patient, how symptomatic the patient is, whether the rates are elevated causing the CRT pacing percentage to be suboptimal a...
What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?
This is an interesting situation that comes up in the routine evaluation of patients with rheumatoid arthritis and other autoimmune syndromes. The normocellular bone marrow suggests a peripheral destruction, in general, and raises some concerns for antibodies directed against neutrophils. These are ...
How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?
I am a little confused by the question. Why would you use TMP/SMX monotherapy for SSTI? During the emergence of CA-MRSA, cephalexin with or without TMP/SMX had the same efficacy rates (Pallin). I agree with Dr. @Dr. First Last; linezolid is a great choice if MRSA is a concern. Cephalexin or cefadrox...
Do you recommend patients temporarily hold cilostazol prior to and after a kidney biopsy?
Kidney biopsy is considered a high-risk bleeding procedure by SIR (Society of Interventional Radiology).Cilostazol is a PDE inhibitor leading to the inhibition of platelet aggregation. The Drug has a half-life of 10 hours. In the past, it was recommended to stop the drug at least 24 hours before a p...