Apixaban (Eliquis) Prevents Recurrent DVT-PE Long-Term People with unprovoked venous thromboembolic disease (pulmonary embolism or deep venous thrombosis, or DVT) are at high risk for recurrence, and current ACCP guidelines advise consideration of “indefinite” anticoagulation. Warfarin (Coumadin) is a wonder drug efficacy-wise, reducing the risk of pulmonary embolism and deep venous thrombosis by ~90%. However, [... read more]
FDA Approves Breo Ellipta, Once-Daily LABA/ICS for COPD The FDA approved the new drug Breo Ellipta as a once-daily inhaled therapy for chronic obstructive pulmonary disease (COPD). Breo Ellipta includes the corticosteroid fluticasone, and vilanterol — a once-daily long acting beta agonist — in a combination dry powder inhaler. This was the FDA’s first approval [... read more]
Killer Carbapenem-Resistant Bacteria Spreading Across U.S. Gut-living bacteria like Klebsiella are gaining resistance to carbapenems at an alarming rate, and long-term acute care hospitals (LTACs) and nursing homes seem to be the incubators for these killer bugs spreading across the U.S. Carbapenems like meropenem and doripenem have been the gold standard to treat infections from [... read more]
Families Allowed to Witness CPR Felt Better, Had Fewer Regrets Should family members be allowed, or even encouraged, to witness the health care team’s attempts to revive their family member with CPR after a cardiac arrest? In the interests of openness and transparency, many have argued “yes,” with the thought that witnessing the heroic efforts [... read more]
PulmCCM’s staff (me) will be on vacation and as far offline as possible for the next couple of weeks. In my absence, all PulmCCM-related matters will be handled by my wife’s cat Gabe, who will try to respond to emails the best he can. Meanwhile, check out EMCrit and Life In The Fast Lane for [... read more]
image: wikimedia Pulse Oximetry: The 30-Second Time Machine Why does it seem to take so long to re-oxygenate your crashing patient? Because your pulse oximeter is lying to you, no matter how good it is. Telescopes show us how a star looked millions or billions of years ago; pulse oximeters create a similar, though tiny [... read more]
Whenever I have residents rounding with me, there are a few exercises I have them go through. Often the most revealing to them is when I ask them to spend a day recording each diagnostic or therapeutic act they do, and classifying them as based on either evidence, physiology, or culture – meaning they learned [... read more]
Chronic Cough and Reflux: A Tangled Relationship Although we’re taught that gastroesophageal reflux disease (GERD) is a major cause of chronic cough, the truth may be more complicated, and confusing. A meta-analysis by Peter Kahrilas et al in Chest examining trials of acid-suppressing treatments for chronic cough found no significant benefit of treatment in 7 [... read more]
image: Wikimedia Inferior Vena Cava Filters: What’s the Harm? Do inferior vena cava filters actually create more harm than health? That’s the provocative question being posed by authors and editorialists in JAMA Internal Medicine. Inferior vena cava filters are frequently placed after a pulmonary embolism (PE) or deep venous thrombosis (DVT) in patients with a [... read more]
As I described at the launch of the PulmCCM crowdfunding campaign, advertising pays the basic bills for PulmCCM but not the expenses needed to help get the project to the next level: authors’ fees, iPhone / Android app redesigns and development, website programming services and steps toward CME certification. Together these will run well into [... read more]
PulmCCM Debuts the New “Doximity Button” Are you on Doximity yet? It’s the brainchild of Internet health-tech visionary Nate Gross and the founders of Epocrates. It’s been called “Facebook for doctors,” but Doximity is more than that. It’s a protected, HIPAA-compliant online environment for physicians to communicate securely, and has the potential to change how we [... read more]
The following is a guest post from Dr. Jonathan Weiss; the views expressed are his own. Submit your own guest post to PulmCCM, and be heard by thousands of your colleagues. Maintenance of Certification: Good or Bad? Dear Colleagues, A short history lesson: For years, physicians, upon completing a residency or fellowship, went through a [... read more]
Feds to Big Tobacco on Cigarette Labeling Fight: “Uncle!” The feds are admitting defeat for now in their fight for graphic, negative imagery to be displayed on all cigarette packaging and advertisements. Attorney General Eric Holder announced yesterday that the Justice Department will not ask the Supreme Court to reverse their loss in a federal [... read more]
Hi all, The built-in search engine with PulmCCM’s blogging platform has been good, but not great. As of today, it now has Google search integrated into it (invisibly, but it’s there). After testing it, I have to say it’s now pretty great, thanks to Google’s secret ingredients. Specifically, it’s much more intelligent and accurate with [... read more]
FDA Warns of Sudden Cardiac Death Risk from Azithromycin Last summer, PulmCCM reported on a New England Journal paper suggesting an increased risk of sudden cardiac death in patients taking even a short 5-day course of azithromycin. Yesterday, the FDA expressed its official concern in a Drug Safety Communication and statement to the press on [... read more]
(image: Wikipedia) High-Frequency Oscillatory Ventilation (HFOV) for ARDS Two Randomized Trials: Early HFOV Doesn’t Help, May Harm High-frequency oscillatory ventilation (HFOV) has been proposed as a first-line therapy for acute respiratory distress syndrome (ARDS). By delivering 3-15 breaths per second of tiny tidal volumes (~70 mL), HFOV has appeal as the “ultimate” lung protective ventilator [... read more]
Fecal Transplants Cure C. difficile Infections, When Drugs Can’t Antibiotics are what cause Clostridium difficile infection to emerge in the first place, so it’s perhaps no surprise that the usual treatment — more antibiotics — often fails. From 15-25% of patients with C. difficile are not permanently cured by their initial treatment with metronidazole, and among those [... read more]
Blood Transfusion: Deadly for GI Bleeds? You read the headline right: in a randomized trial published in the January 3 New England Journal of Medicine, liberal blood transfusions (to a hemoglobin of 9 g/dL) seemed to cause the deaths of people with acute upper gastrointestinal bleeding, as compared to transfusing when hemoglobin fell below 7 [... read more]
Visual learners can see continuous positive airway pressure (CPAP) work for obstructive sleep apnea in realtime in this NEJM video. But how on earth does someone sleep inside an MRI machine? See the Sleep Apnea Video
Thanks to you, PulmCCM had an incredible year in 2012, growing from Internet blip to one of the most-visited medical blogs, with over 50,000 visits and 150,000 page views monthly worldwide. Now, I’m asking you for your financial support, and in return, offering you the chance to share in PulmCCM’s success in 2013. To grow [... read more]