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Author Archives: Amy
Lumbar puncture/Procedure considerations/Neuroimaging in Dynamed The section on Testing to Consider Prior to Performing an LP in DynaMed’s entry for lumbar puncture summarizes two prospective cohort studies and lists clinical findings such as age and aspects of clinical history and … Continue reading
How can the Simplified Pulmonary Embolism Severity Index (sPESI) be used to manage patients presenting with a pulmonary embolism?
The Bottom Line: The Pulmonary Embolism Severity Index is a validated tool for predicting 30-day mortality in patients presenting at the hospital with PE. The Simplified PESI (sPESI) predicts 30-day mortality with accuracy similar to the PESI And can assist … Continue reading
Bottom line: Compared to LMWH The new oral anticoagulants (NOACs) are safe and effective for treatment of thromboembolism. Rivaroxaban and apixiban have lower bleeding risk compared to warfarin therapy. Summary: Lana A. Castellucci, et al. Clinical and safety outcomes associated with … Continue reading
What is the predictive value of blood pressure differential in predicting aortic dissection in patients with chest pain?
Bottom line: Presence of chest pain with blood pressure differential and/or pulse differential should raise clinical suspicion of aortic dissection. There is evidence that the presence of pressure difference >20mmHg is a strong predictor of dissection, but absence of pressure differential should … Continue reading
In patients with suspected pyelonephritis, how useful is the finding of costovertebral (CVA) tenderness?
Bottom line: A finding of CVA tenderness on physical exam does not by itself significantly raise the suspicion of UTI to confirm diagnosis, but can combine with other findings, such as hematuria and dysuria, to guide decision-making. Summary: The diagnostic usefulness of … Continue reading
Bottom line: ACE inhibitors protect kidney function by decreasing glomerular capillary pressure and by reducing exposure to proteins which could cause proliferation of mesangial cells and matrix. Summary: According to Goodman & Gilman’s Pharmacological Basis of Therapeutics [AccessMedicine], ACE inibitors … Continue reading
Bottom line: Klebsiella pneumonia is one of the gas-forming organisms most frequently associated with emphysematous cystitis. Summary: Amano M, Shimizu T. Emphysematous cystitis: a review of the literature. Intern Med. 2014;53(2):79-82. Emphysematous cystitis is a rare disease where microbes form … Continue reading