Confused about when to give steroids in severe pneumonia, if ever? Turns out they are only useful in patients with high CRP (≥205 mg/L). From a great talk today by Mike Klompas #IDSky

Allergy updates today from Paige Wickner, including clinical pearls on contrast allergy #MedEd

Great talk from Jean Connors today on anticoagulation and hypercoagulable states! Clinical pearl: clinical outcomes may be better with warfarin than DOACs in patients with BMI >40

Old man post: when I was an intern, digoxin was a go-to med for heart failure, but it is all but forgotten today. A new study in @nejm.org found that digitoxin reduced the combined end-point of death or CHF hospitalization in patients maxed out on guideline-directed medical therapy

New in peri-operative medicine: two strategies for blood pressure management in non-cardiac surgery (hypotension-avoidant and hypertension-avoidant) had no effect on delirium risk or long-term cognitive outcomes #hospmed #medsky

Interesting subset analysis of HIP ATTACK trial, showing lower mortality in patients with hip fracture and elevated troponins if they get surgery within 6 hours of diagnosis Surgery is often delayed in this group because of cardiac concerns, but this data suggests that this is the wrong approach

1/2 Congrats to our very own Dr. Dustin Smith who was featured in The Hospitalist this month as he discussed his strategies for balancing clinical demands and teaching! You can read more here: www.the-hospitalist.org/hospitalist/... #WeAreEHM @emorydeptofmed.bsky.social

Interesting finding from this study: patients in rooms with manual paper towel dispensers are at higher C difficile risk than those in rooms with automated ones

ID Consultation Nugget - please please please exchange a chronic catheter before taking a urine culture from it. Otherwise we are culturing the tubing which is open to the world. Also urinalysis with urine culture is always helpful, along with assessment for symptoms #IDSky

Practice changing thoughts from @jasmohanbajaj.bsky.social about the weak evidence for antibiotic prophylaxis for spontaneous bacterial peritonitis, just published in @cidjournal.bsky.social

So much this. People don't realise how much of hospital medicine is getting people OFF unnecessary drugs due to the side-effects and keeping the helpful ones going.

Public service announcement from addiction medicine and an Important article for my hospital medicine colleagues: Use methadone! It works and there is no reason to avoid it. #stoppuntingtopsychiatry this is well within your scope. #medsky

At the Boston Medical Center, their Clean Power Prescription program will help 80 patients with complex, chronic medical needs keep the lights on. 519 solar panels installed on the hospital's roof are split b/w powering the hospital & reducing patients' utility bills. www.npr.org/sections/sho...

A new Review Article focuses on drug reaction with eosinophilia and systemic symptoms, or DRESS, a serious drug-induced T-cell–mediated condition with marked cutaneous and systemic effects. Read the full review: nej.md/3ONkyL9 #MedSky

Pretty much use metronidazole 500mg q12 for all indications aside from CNS at this point

Another reason to hate IV hydralazine? Sign me up!

New approach to treating COPD flares: giving corticosteroids only if blood eosinophils are elevated reduces hyperglycemia and is non-inferior to conventional therapy. From Craig Hersh' excellent talk today #MedEd

New approach to treating COPD flares: giving corticosteroids only if blood eosinophils are elevated reduces hyperglycemia and is non-inferior to conventional therapy. From Craig Hersh' excellent talk today #MedEd

From Marc Sabatine's talk on acute coronary syndromes: troponins are much more sensitive than older cardiac biomarkers, such as CK-MB. High-sensitivity troponins can be repeated in as early as one hour to rule in or rule out myocardial infarction

Heart failure pearl from Anju Nohria: crackles are not a sensitive physical exam finding for heart failure! Only 15% of patients have crackles involving one-third or more of the lung fields, due to lymphatic compensation. Elevated jugular venous pressure is the most sensitive physical finding

From Mike Klompas' bacteremia talk: PET CT has a high yield for revealing unsuspected sites of infection in Staph aureus bacteremia #MedEd #IDSky

Agustina Saenz on artifical intelligence and the hospitalist (including liability issues): one of over outstanding 40 talks at this year's Brigham Update in Hospital Medicine! #HMShospmed24 hospitalmedicine.hmscme.com/registration...

The debate about whether to stop ACE inhibitors and ARBs before major noncardiac surgery is (probably) over. According to a new RCT, it makes no difference--mortality and complications were the same in both arms

We mourn the sudden loss of our friend Galen Henderson, director of the neuro ICU at the Brigham, and one of our most popular speakers. Galen wrote of his journey from rural Mississippi to Harvard, and the challenges of "doctoring while black," in this essay medicine.at.brown.edu/article/doct...

Apixiban reduces stroke rates in subclinical atrial fibrillation, compared to aspirin, but was associated with higher rates of bleeding. No difference in intracranial bleeding or mortality between groups www.nejm.org/doi/full/10....

Take home points from a great COVID-19 update today by @paulsaxmd.bsky.social!

How long should dual-antiplatelet therapy be continued after cardiac stenting? The answer: it depends on bleeding risk. From Marc Sabatine's talk on acute coronary syndromes at this year's course

Should we use the daptomycin/ceftaroline combo for all cases of Staph aureus bacteremia? In a retrospective cohort, early switch to dapto/ceftaroline was associated with faster clearance of bacteremia and a trend toward lower mortality. From Jen Johnson's excellent antibiotic talk today #IDSky

A good 16-gauge peripheral IV provides a higher volume of fluid than all 3 lumens of a triple lumen angiocath combined. Shocking info on fluid resuscitation from Tyler Berzin's excellent GI bleeding talk today

Need a liver transplant? Your best bet might be to move to Florida. Advice that you hopefully won't need, from Anna Rutherford's excellent cirrhosis talk at #HMShospmed2023

Hearing loss increases fall risk by 2.4 times in the elderly, due to lower awareness of people, pets, and objects, and mental preoccupation with straining to hear. Hearing aids eliminate this excess fall risk. From Shoshana Streiter's excellent #geriatrics talk today #MedEd

A standardized pain management pathway, with ample use of acetaminophen/ibuprofen, lidocaine patches, heat/cold Rx, and IV ketorolac, and emphasizing oral opioids over IV, eliminated racial and first-language disparities in opioid prescribing at Brigham and Women's

GPT-4 is better at the USMLE than you are. From Agustina Saenz's excellent talk on AI at this year's course

New therapy for C difficile: live-brpk (Vowst) is given after vancomycin or fidaxomicin in patients at high relapse risk. It seems to be as effective as fecal transplantation (the current "brown standard"), but it is prohibitively expensive at present

Over 2 billion people fly per year but what happens when they get sick? NEW ICU OnePager about in-flight medical emergencies. ✈️covers aerospace physiology 🩹medical supplies & equipment 🛬logistics & diversion 🤒what to do for common in flight medical emergencies - onepagericu.com/in-flight-medi…

Lisa Vercollone on methadone initiation for opioid dependence at #HMShospmed2023. Her preference is Option 2 (methadone 30 mg x one dose, plus another 10 mg in >4 hrs on Day 1 if needed for withdrawal) #MedEd

Treatment summary for drug rashes in the hospital setting from Alexandra Charrow. Stevens-Johnson and DRESS syndromes (Drug Rash with Eosinophilia and Systemic Symptoms) are treated with systemic corticosteroids. Morbilliform rashes and AGEP are treated supportively #MedEd #Medsky

The most common causes of Stevens-Johnson/toxic epidermal necrolysis can be grouped into "four big buckets": TMP-SMX, beta-lactams, anticonvulsants, and allopurinol. Alexandra Charrow at #HMShospmed2023 Medsky Meded

The most common cause of morbilliform rashes (measles-like maculopapular rashes) in the hospital is antibiotics, especially penicillins, cephalosporins, and TMP-SMX. Typical timing is 7-14 days after drug initiation. Excellent talk by Alexandra Charrow on hospital derm #HMShospmed2023 #Medsky

There is an emerging body of evidence for the use of DOACs in cancer-associated thrombosis (although patients with GI tract cancers may be more prone to bleeding with these agents). Jean Connors at #HMShospmed2023 #MedSky #Medsky

False positive screening tests for lupus anticoagulants are extremely common in patients with acute medical illness or who are on anticoagulants! From Jean Connors' talk at #HMShospmed2023 #MedSky

25% of all venous thromboembolism events are attributable to obesity. From Sam Goldhaber's excellent VTE talk at #HMShospmed2023