QOD

Anemia, when to transfuse?

2010-01-15T05:49:40Z

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?

Massive PE and thrombolysis?

2009-12-17T10:06:38Z

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

Febrile neutropenic patient and urinary retention?

2009-11-04T21:24:00Z

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

Stroke Prevention in pt with Afib and ESRD on HD?

2009-11-02T10:02:14Z

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

When to act if empyema suspected?

2009-10-28T07:02:38Z

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

Aspergillus & HIV infection

2009-10-27T08:50:52Z

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

41 y F c liver failure, dx & tx?

2009-10-23T22:30:17Z

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

Can you dx diabetes in the inpatient setting?

2009-10-22T15:03:46Z

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

Cardiorenal syndrome & diuretic resistance, when to stop?

2009-10-21T04:46:25Z

In cardiorenal syndrome with diuretic resistance, how high can we drive the creatinine level before stopping the use of furosemide?

- submitted by Juana Gonzalez

CHF or COPD?

2009-10-20T01:12:21Z

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

Mgmt prenal azotemia in a patient with heart failure?

2009-10-16T23:07:30Z

In an elderly patient with heart failure who presents with prerenal azotemia, what therapeutic measures would you undertake to protect their kidneys?

- submitted by Michael Bazylewicz

R/O Pulmonary Embolism?

2009-10-16T05:43:51Z

In a patient with moderate risk by the Well's Criteria for PE and renal insufficiency (creatinine clearance < 45 mL/min) and , how can I rule out pulmonary embolism?

- submitted by Michael Bazylewicz