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]
Use of Procalcitonin to Reduce Unnecessary Antibiotics by Blair Westerly, MD Acute respiratory tract infections have a wide range of disease severity and the use of antibiotics for self-limited infections contributes to antibiotic overuse and antimicrobial resistance, though we have all probably been guilty of it a time or two when we just weren’t sure [... 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: Radiology Assistant Ground-Glass Nodules: If Growing, Assume Cancer Blair Westerly, MD The more CT scans that are performed, the more ground-glass opacities (GGO’s) are seen and what to do with these abnormalities can be difficult to ascertain for clinicians. With the National Lung Cancer Screening Trial showing a mortality benefit from low dose CT [... 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]
In ARDS, Obesity May Protect Life (But Not Kidneys) by Blair Westerly, MD Obesity is an epidemic and common in intensive care units in the United States. Furthermore, while acute kidney injury (AKI) is also common in critically ill patients, obese patients carry additional risk for AKI because of increased baseline comorbidities. Both obesity and [... read more]
The 2011 GOLD classification for COPD: Old GOLD vs. New GOLD Guidelines by Brett Ley, MD Ever had a COPD patient with an awful FEV1, yet who seems to be cruising along, doing fine for years? How about a COPD patient with a relatively preserved FEV1, yet always seems to be in your clinic or [... read more]
Acetazolamide Improved Obstructive Sleep Apnea at High Altitudes by Blair Westerly, MD Obstructive sleep apnea (OSA) is common, and so is travel to the mountains for work and play, therefore encounters with patients with OSA who travel to mountain destinations is not infrequent. We all learn early in training that altitude affects oxygenation, and patients [... 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]
Interventions to Improve Symptoms, Quality of Life in Fibrotic ILD: Do They Work? by Brett Ley, MD Patients with fibrotic interstitial lung diseases (e.g. idiopathic pulmonary fibrosis) have a poor overall prognosis, and there are no therapies proven to halt disease progression or extend life. Further, many of these patients have debilitating symptoms, limited functional [... read more]
Why Patients with PEs Shouldn’t Love the Weekend Hospitals big and small struggle with weekend staffing models. Mortality has been shown to be higher on the weekend for several common life-threatening illnesses, including CHF exacerbations, acute MI, upper GI bleeds and intracerebral hemorrhage. All these conditions are known to benefit from early intervention; however, whether [... 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]
“Like this … kind of” Passive Leg Raise Improved Management of Patients in Shock* (*some assembly required) by Blair Westerly, MD Providing the right amount of fluid is vital in a critically ill patient, as both too little and too much can result in poor outcomes. Yet even with this understanding, the clinical assessment of [... read more]