We know from the Hebert et al (NEJM 1999, Crit Care Med 2001) that most critically ill patients with anemia should be transfused to maintain a hemoglobin of 7.0-9.0 g/dL and Wu et al (NEJM 2001) showed that elderly people with myocardial infarctions should be transfused to maintain a hematocrit between 30-33%, therefore, should critically ill patients with ESRD be transfused to maintain a hemoglobin between 11-12.0 g/dL, and if not, what should that target be?
In a patient with symptomatic pulmonary embolism wherein recommended doses of thrombolytic therapy is contraindicated because of recent surgery or GI bleeding, is low-dose, long-term thrombolytic therapy a useful adjunctive measure?
- submitted by Patrick Bui
In a febrile neutropenic patient who has urinary retention and suprapubic pain, 1.0L on bladder scan, is suprapubic drainage safer than straight cath, and when is a foley catheter contraindicated in a neutropenic patient?
- submitted by Michael Bayzlewicz
We know that warfarin decreases the risk of stroke in patients with atrial fibrillation. In a patient with atrial fibrillation & ESRD on HD who has an increased risk of bleeding, is warfarin an effective drug to use in stroke prevention?
- submitted by Patrick Bui
In an ICU patient with necrotizing pneumonia who has persistent leukocytosis despite adequate antibiotic coverage and an X-ray (see attached) suggestive of empyema, when do you get a computed tomography scan of the chest or therapeutically drain it?
- submitted by Nancy Huh
EK
JD
MB
MS
YH
- submitted by Nancy Huh
EK
JD
MB
MS
YH
If neutropenia is a risk factor for aspergillosis, why do people with HIV not have an increased incidence of the disease?
- submitted by J.P. Yu
- submitted by J.P. Yu
41 year old lady with a recent diagnosis hyperthyroidism presents with fever (39 C), pharyngitis, maculopapular rash on her trunk. She discontinued methimazole 3 weeks ago. Her CT abdomen is negative for obstruction of the common bile duct or evidence of cholecystitis. What is the best management of this patient?
Labs
WBC 0.8 K/microL
Total Bilirubin 13.3 mg/dL
Direct Bilirubin 9.5 mg/dL
ALT 187 Units/L
AST 83 Units/L
Alk Phos 407 Units/L
TSH < 0.02
Free T4 3.7
Hep A IgM negative / Hep B sAg negative / Hep B cAb IgM negative / Hep C Ab negative
A 65y lady is s/p anterior cervical diskectomy & fusion with an AM blood glucose of 230. She has been NPO for more than 12 hours. She has not received dextrose solution.
Her medications include:
hydrochlorthiazide
beclomethasone
cefazolin
Can you make the diagnosis of diabetes in this patient?
- submitted by Michael Bazylewicz
In cardiorenal syndrome with diuretic resistance, how high can we drive the creatinine level before stopping the use of furosemide?
- submitted by Juana Gonzalez
In an elderly patient with history of CHF & COPD who presents to the ER with shortness of breath, how can I differentiate the underlying etiology?
- submitted by Elena Shagisultanova
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