Clinical

Early, Goal-Directed Therapy Doesn’t Improve Mortality in Patients with Early Septic Shock

Clinical question: Does early goal-directed therapy (EGDT) improve mortality in patients presenting to the ED with early septic shock? Background: EGDT (achieving central venous pressure of 8-12 mmHg, superior vena oxygen saturation (ScvO2) of > 70%, mean arterial pressure ≥ 65mmHg, and urine output ≥ 0.5 mL/kg/h) has been endorsed by the Surviving Sepsis Campaign as a key strategy to… [Read More]

Arterial Catheter Use in ICU Doesn’t Improve Hospital Mortality

Clinical question: Does the use of arterial catheters (AC) improve hospital mortality in ICU patients requiring mechanical ventilation? Background: AC are used in 40% of ICU patients, mostly to facilitate diagnostic phlebotomy (including arterial blood gases) and improve hemodynamic monitoring. Despite known risks (limb ischemia, pseudoaneurysms, infections) and costs necessary for insertion and maintenance, data… [Read More]

Bedside Attention Tests May Be Useful in Detecting Delirium

Clinical question: Are simple bedside attention tests a reliable way to routinely screen for delirium? Background: Early diagnosis of delirium decreases adverse outcomes, but it often goes unrecognized, in part because clinicians do not routinely screen for it. Patients at high risk of delirium should be assessed regularly, although the best brief screening method is… [Read More]

What Should Hospitalists Know about Transarterial Liver Tumor Therapies?

What Should Hospitalists Know about Transarterial Liver Tumor Therapies?

Case A 51-year-old male with known hepatocellular carcinoma (HCC) recently underwent successful transarterial chemoembolization of a segment VII liver lesion. The patient was admitted to the hospitalist service for overnight observation. Soon after being sent to the floor, he developed a large mass in his right groin, with associated erythema and tenderness. Upon examination, the… [Read More]

Magnifying glass

Fluid Resuscitation in Sepsis: A Systematic Review and Network Meta-Analysis

Clinical question: Is there any difference between different resuscitative fluids (crystalloids or colloids) on mortality in critically ill sepsis patients? Background: Fluid resuscitation, in addition to antibiotics and source control, is a cornerstone of initial management of sepsis. Resuscitation with crystalloids compared with colloids for critically ill patients has been evaluated in large randomized controlled… [Read More]

Intermittent PPI = Continuous-Infusion PPI for High-Risk Bleeding Ulcers

Clinical question Is intermittent proton pump inhibitor (PPI) therapy comparable with continuous-infusion PPI for the treatment of patients with high-risk bleeding ulcers who have undergone endoscopic therapy? Bottom line For patients with high-risk bleeding ulcers who have been treated endoscopically, treatment with intermittent proton pump inhibitor (PPI) therapy is as effective as continuous infusion of… [Read More]

PEG Better and Faster than Lactulose for Initial Treatment of Hepatic Encephalopathy

Clinical question Is polyethylene glycol 3350-electrolyte solution an effective treatment for hospitalized patients with acute hepatic encephalopathy? Bottom line Polyethylene glycol 3350-electrolyte solution (PEG) is a safe and effective therapy for the initial treatment of acute hepatic encephalopathy (HE) in hospitalized patients. As compared with lactulose alone, the use of PEG alone during the first… [Read More]

Who Should Be Screened for HIV Infection?

Who Should Be Screened for HIV Infection?

Case A 31-year-old male with a history of asthma is admitted with an asthma exacerbation. He has no regular outpatient provider. He denies tobacco use and reports that he is in a monogamous relationship with his girlfriend. On rounds, a medical student mentions that new HIV screening guidelines have been released recently and asks whether… [Read More]

Sleep Apnea Should Be Addressed in Heart Failure Population

Before you fall asleep at the thought, consider the fact that sleep apnea has been identified as a major contributing factor in new onset atrial fibrillation (Afib), acute ischemic stroke, and heart failure. How well are inpatients, in particular those with heart failure, being screened and treated for sleep apnea? To answer this question, the… [Read More]

Ebola Treatment Centers Needed in North America

As the hysteria about Ebola spreads, hospitalists who have been running most of the country’s ICUs will find themselves at the forefront of treating these patients when more of them present at our different hospitals. It is now time for America to come into the age of Ebola and treat Ebola patients in Ebola centers,… [Read More]