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Family Practice Notebook Updates 2022
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Family Practice Notebook Updates 2022
, FPN Updates 2022
See Also
Family Practice Notebook Updates 2022
Family Practice Notebook Updates 2021
Family Practice Notebook Updates 2020
Family Practice Notebook Updates 2019
Family Practice Notebook Updates 2018
Family Practice Notebook Updates 2017
Family Practice Notebook Updates 2016
Family Practice Notebook Updates 2015
Family Practice Notebook Updates 2014
Family Practice Notebook Updates 2013
Updates
December 2022
Systemic Lupus Erythematosus
(rheum, diffuse)
Updated with 2019 ACR/EULAR diagnostic criteria
Thanks to Komkwuan Paruchabutr for bringing the 2019 guidelines to my attention
Relative Bradycardia
(cv, ekg)
Updated causes including
Relative Bradycardia with Hypotension
Shock Index
(cv, exam)
Updated, including added
Diastolic Shock Index
Massive Hemorrhage Protocol
(hemeonc, pharm)
Updates including to
Hemorrhage Management
FAST Exam
(er, rad)
Updates
Modified Sgarbossa Criteria
(cv, ekg)
Updates
Heart Transplant
(cv, surgery)
Updates regarding denervation, ekg, infection and rejection
Transplantation
(surgery, prevent)
Updates related to
Solid Organ Transplant
,
Transplant Rejection
,
Stem Cell Transplant
Cholangitis
(surgery, gi)
Extensive updates
Dexmedetomidine
(surgery, pharm)
Updates
Biosimilars
(id, pharm)
Updates, including
Adalimumab
, which will now have up to 12 new
Biosimilars
in 2023
Warfarin
(hemeonc, pharm)
Added specific indications where
Warfarin
is preferred over
DOAC
s
Hormone Replacement
(gyn, pharm)
Updates including
Vaginal Estrogen
Calcium Channel Blocker
s (cv, pharm)
Updates to various drugs within class
Musculoskeletal Injury
(er,
Trauma
)
Updates to specific nerve injuries (also updated
Motor Exam
and
Sensory Exam
)
Burn Injury
(er, environ)
Updated fluid management
Medication Route
(pharm, medication)
Added
Drug Metabolism
(pharm, medication)
Extensive updates
STONE Score
(urology, exam)
Added
Ureterolithiasis
(urology, renal)
Updates
Mesenteric Ischemia
(surgery, gi)
Extensive updates
Tobacco Cessation
(psych, cd)
Updates
Post-Covid Long-Term Effects
(lung, id)
Added
Adult Immunization
(id, immunize)
Updates
Sports Related Trauma
(er, sports)
Updates including
Sideline Medical Evaluation
Nocturnal Enuresis
(urology, peds)
Extensive updates
Montreal Cognitive Assessment
(neuro, exam)
Added
Edema
(renal, edema)
Updates
Vasomotor Symptoms of Menopause
(gyn, sx)
TSEC
added
Hydrocortisone
(endo, pharm)
Updates
SGLT Inhibitors (endo, pharm)
Updates
Tongue Laceration
(ent,
Tongue
)
Added
Hospital Discharge Planning
(geri, manage)
Individualized discharge plans result in shorter hospital stays and lower readmission rates in older patients (over age 60 years)
Transitions of Care
(geri, prevent)
Extensive updates regarding indications and options
Also added
Longterm Care
definitions
Monkey Pox
(id, virus)
Updates regarding STD related cases
COPD
Exacerbation (lung, copd)
Doxycycline
has fallen out of favor for
Antibiotic Use in COPD Exacerbation
due to lack of efficacy
Thank you to Justin Chua, DNP for alerting me to this recommendation
Ibuprofen
(pharm,
Analgesic
)
Ibuprofen
Analgesic
ceiling is 400 mg
Doses 600 mg and 800 mg offer little additional
Analgesic
benefit above the 400 mg dose
Hypopigmentation
(derm, exam)
Updated
Slipped Capital Femoral Epiphysis
(ortho, peds)
Updated
Verquvo
(cv, pharm)
Added
Procalcitonin
(hemeonc, lab)
May allow shortening of
Antibiotic
course in
Sepsis
and respiratory infections without adversely affecting outcomes
Knee Osteoarthritis Management
(rheum,
Osteoarthritis
)
Triamcinolone
40 mg gluteal IM had equivalent efficacy compared with intraarticular injection at 8 and 24 weeks
However, intraarticular injection was superior to IM at 4 weeks
Osteoporosis Management
(rheum, bone)
Updates
Sepsis
(id, fever)
Updates
Pharmacology
(pharm, medications)
Added with definitions and mechanisms
Also added an entry on
Drug Metabolism
Updates
November 2022
Vegetarian Diet
(pharm, nutrition)
Added
Vegetarian Diet
with extensive review
Nutrition Guidelines
(pharm, nutrition)
Extensive Updates
Calciphylaxis
(renal, derm)
Added with extensive review
Percutaneous Nephrostomy
(urology, surgery)
Added
Chest Pain Plus
(cv, sx)
Added DDX and addressed in
STEMI
presentations
Moyamoya Disease
(cv, vessel)
Added
Neurocritical Intubation
(er, neuro)
Updates, including adding the term
Amyotrophic Lateral Sclerosis
(neuro, motor)
Extensive updates
Endometriosis
(gyn,
Uterus
)
Extensive updates
Placental Abruption
(ob, antepartum)
Updated with CT for high mechanism
Blunt Abdominal Trauma
Reviewed specific findings and
False Positive
s
Sexually Transmitted Infection
(id, std)
Updates
Sexual Assault
(prevent, abuse)
Extensive updates to the history, exam and specimen collection
Acute Cholecystitis
(surgery, gi)
Updated regarding CT imaging
Covid19
Bivalent Booster
Vaccine
(id, immunize)
Added bivalent booster information
Immunization
s (id, immunize)
Updates
Monkeypox
(id, virus)
Added Tecovirimat dosing
Continuous Glucose Monitor
(endo, pharm)
Updates
Sulfa Allergy
(id, pharm)
Updates
NSAID Renal Adverse Effects
(pharm, renal)
Updates
Blood Urea Nitrogen
(renal, lab)
Updates (thanks to Dr. Juan Fernandez for feedback)
Polymyalgia Rheumatica
(rheum, diffuse)
Extensive updates, including to
Giant Cell Arteritis
Medications that Exacerbate Heart Failure
(cv, pharm)
Updates
Psoriasis
(derm, hyperplasia)
Updates with a few newer, expensive medications
Linear Dermatitis
(derm, exam)
Added
Gastoparesis (gi,
Stomach
)
Updates
Bariatric Surgery
(endo, surgery)
Added image of surgery types
Femur Traction Splint
(ortho, procedure)
Added
Hip Dislocation
(ortho, hip)
Updates
Orthostatic Hypotension
(cv, exam)
Updates
Barrett Esophagus
(gi, hemeonc)
Updates
Breast Cancer Gene Marker
(gyn, lab)
Updated
BRCA
screening indications as well as
BRCA1
and
BRCA2
specific risks
Intrahepatic Cholestasis of Pregnancy
(derm, gi)
Updated with extensive review
Schizophrenia
(psych,
Psychosis
)
Updates
Tricyclic Antidepressant
(psych, pharm)
Gene
ral updates as well as to
Amitriptyline
and
Nortriptyline
Spiritual Assessment
(psych, exam)
Added
Emergency Medical Service
s (er, manage)
Updates
Dinitrophenol Poisoning
(er, toxin)
Added
Updates
October 2022
Opioid Use Disorder
(psych, cd)
Updated, esp. related to
Buprenorphine
Alcoholic Ketoacidosis
(psych, cd)
Added
Thrombocytopenia
(hemeonc,
Platelet
s)
Extensive updates
Geriatric Emergency Care
(geri, prevent)
Updates
Tuberculosis
(lung, Tb)
Updates
Bell's Palsy
(neuro, cn)
Updates regarding
Bell's Palsy
in Children
Malaria
(id,
Parasite
)
Extensive updates
Procalcitonin
(id, lab)
Updates
Parenteral Iron
(hemeonc, pharm)
Updated regarding infection risk
Clostridioides difficile
(gi,
Diarrhea
)
Updates to
Fidaxomicin
Cephalosporin
(id, pharm)
Updates
Bursitis
(ortho, sx)
Updates
Influenza Vaccine
(id,
Vaccine
)
Updates
Monkeypox
(id, virus)
Updates
Systolic Dysfunction
(cv, chf)
Updates regarding management in
Chronic Kidney Disease
Xerostomia
(ent, sx)
Updates
Serotonin Syndrome
(psych, pharm)
Updates
Hearing Aid
(ent, pharm)
Updates
Functional Constipation
(gi,
Constipation
)
Updates
Gastroprotection
(gi, pud)
Updates on oupatient GI prophylaxis indications
Vulvovaginal Candidiasis
(gyn, id)
Updates regarding recurrent candida
Vaginitis
management
Preterm Labor
(ob, antepartum)
Updates
Gestational Diabetes
(endo, ob)
Updates
Carbamazepine Poisoning
(neuro, pharm)
Added to
Carbamazepine
Ectopic Pregnancy
(ob, antepartum)
Updates
Yawning
(lung, sx)
Added
Community-Acquired Pneumonia
(lung,
Bacteria
)
Updates regarding IDSA 2019 guidelines for
Sputum Culture
and
Blood Culture
indications
Eye Irrigation
(eye, procedure)
Updates
Talus Fracture
(ortho, ankle)
Updates
Depression in Older Adults
(psych, geri)
Updates
Aspirin
(pharm,
Analgesic
)
Updated
Aspirin
indications regarding
Cardiac Risk Management
Erythema Nodosum
(derm, rheum)
Updates, esp. causes
Rheumatoid Arthritis Remittive Agent
s (rheum, ra)
Updates
Updates
September 2022
Hepatitis B Vaccine
(id, immunize)
Universal
Hepatitis B Vaccine
is recommended for all adults under age 60 years
Insect Bite
s (er, derm)
Extensive updates
Diverticulitis
(gi, bowel)
Extensive updates
Clogged Feeding Tube
(gi, procedure)
Updates
Tracheostomy
(lung, procedure)
Updates
Status Asthmaticus
(lung,
Asthma
)
Updates
In-Flight Medical Emergency
(id, travel)
Added inflight
Vaginal Delivery
guidance
Venous Catheter Site Bleeding
(er, procedure)
Added Woggle Technique
ST Elevation
(cv, exam)
Updated causes
Takayasu Arteritis
(rheum, cv)
Updates
Cardiopulmonary Resuscitation in Pregnancy
(er, ob)
Added the
ACLS
Mnemonic ABCDEFG for differential diagnosis
ST Elevation
(cv, exam)
Updates to diffuse
ST Elevation
Pediatric Advanced Life Support
(er, exam)
2019 guideline updates
Cervical Artery Dissection
(neuro, cv)
Updates
Abdominal Aortic Aneurysm
(surgery, cv)
Updated
Scrotal Mass
(urology, sx)
More updates
Transcutaneous Pacing
(cv, procedure)
Added
Multiple Sclerosis
(neuro, demyelinating)
Extensive Updates
Neurologic Multimodal Prognostication After Cardiac Arrest
(er, exam)
Added to
ROSC
management
Anxiety Disorder
(psych, anxiety)
Various updates to
Anxiety Disorder
s, GAD, panic and their management
Hemophagocytic Lymphohistiocytosis
(hemeonc, marrow)
Added
Iron Supplementation
(hemeonc, pharm)
Oral iron is as effective as
Parenteral Iron
in preventing
Blood Transfusion
and mortality
Oral iron is preferred in those without significant malabsorption or other barriers to oral ingestion
G6PD Deficiency
(hemeonc,
Hemolysis
)
Important updates to
Medications in G6PD Deficiency
Updates including class system, epidemiology, pathophysiology
Laryngospasm on Induction
(lung, procedure)
Updates
Statin Intolerance
(cv, pharm)
Updates
SMART Asthma Management Protocol
(lung, pharm)
Updates to protocol
Aloxi
(gi, pharm)
Corrected
Aloxi
dose (thanks to Deepa Chacko)
LAST Reaction
(surgery, pharm)
Corrected dosing (after giving
Intralipid
for ED patient, post-dental procedure with
Lidocaine
neurotoxicity)
Prolonged QT Interval due to Medication
(cv, pharm)
Updated
Potassium Competitive Acid Blocker
(gi, pharm)
Added this new class (
PCAB
) with
Vonoprazan
(
Takecab
) - the prototype drug
Potassium Competitive Acid Blocker
(
PCAB
) blocks both active and resting proton pumps, with activity onset within hours regardless of timing with meals
Contrast with
Proton Pump Inhibitor
s, which block only active proton pumps, with full action delayed up to 7 days, and best taken 30 to 60 minutes before a meal
Vaccination
(id, immunize)
For kindergarden entry, 94% of children are up to date on
Vaccination
in U.S. (79 to 98% depending on state)
In the U.S., only 60% of teens were current on routine
Vaccination
pre-
Covid19
in 2020 (trending down since then)
Lyme Disease
(id, vector)
Updates
Direct Oral Anticoagulant
(hemeonc, pharm)
Added precautions related to dosing
Aphthous Ulcer
(ent, mouth)
Updates with additional treatment options
Superficial Folliculitis
(derm, hair)
Updates
Left Atrial Appendage Closure Device
(cv, procedure)
Reduces stroke risk when implanted after cardiac surgery for other reason
Pediatric Fractures
(ortho, peds)
Ultrasound
is accurate for upper extremity
Fracture
detection (except at the elbow)
Lisfranc Fracture Dislocation
(ortho, foot)
Updates
Myositis Ossificans
(ortho, hip)
Updates
Antibiotic Associated Diarrhea
(id, pharm)
Probiotic
s reduce risk (NNT 13 to 20)
Green Nail Syndrome
(derm, nail)
Updates
Drug-induced Photosensitivity
(derm, pharm)
Updates
Dexmedetomidine
(surgery, pharm)
Dexmedetomidine
(
Precedex
) is now available in sublingual form
Colonoscopy Bowel Preparation
(gi, procedure)
Updated
Constipation Management
(gi,
Constipation
)
Updated protocols
Triptan Overdose
(neuro, pharm)
Added info to
Triptan
page
Dispelling Health Misinformation
(manage, communication)
Added the 3C approach
Shared Decision Making
(manage, communication)
Extensive updates including NICE guidelines, numerical data best practices and three talk model
Medical Cannabis
(gi, pharm)
Updates
Updates
August 2022
Brainstem CVA
(neuro, cv)
Added various
Brainstem Syndrome
s (thanks to Dr. Sourabh Jain)
Intracerebral Hemorrhage
(neuro, cv)
Updates
Spinal Epidural Abscess
(ortho, id)
Updates
Drowning
(sports, water)
Extensive updates
Active Female
(sports, gyn)
Updates including to
RED-S
(replaces
Female Athlete Triad
),
Exercise in Pregnancy
Abdominal Pain in Pregnancy
(surgery, ob)
Updates including imaging the RLQ
Preeclampsia Prevention
(cv, ob)
Consistent
Exercise
initiated in early pregnancy reduces the risk of developing
Gestational Hypertension
and
Preeclampsia
Blood Type
(hemeonc, lab)
Updates to
Blood Type
, INR,
Clotting Pathway
,
Perioperative Anticoagulation
Retropharyngeal Abscess
(ent, mouth)
Updates
Intranasal Analgesics in Children
(pharm, peds)
Updates
Esophageal Rupture
(gi,
Esophagus
)
Updates
Inflammatory Bowel Disease
(gi, ibd)
Updates
Rectal Prolapse
(gi,
Rectum
)
Updated including reduction technique
Low Back Pain
(ortho, sx)
Updates, including
Low Back Pain Red Flag
s
Patellar Fracture
(ortho, knee)
Updates
Celiac Disease
(gi, malabsorption)
Updates
Acute Pancreatitis
(gi,
Pancreas
)
Updates
Acute Diarrhea
(gi,
Diarrhea
)
Updates
Perirectal Abscess
(gi,
Rectum
)
Updates
Pilonidal Abscess
(gi,
Rectum
)
Updates
Urinalysis
(urology, lab)
Extensive updates to all components of the
Urinalysis
Alzeimers Disease (neuro, cognitive)
PrecivityAD is a lab marketed for age 60 years old and older with
Cognitive Impairment
Combines 2 tests: ApoE
Genotype
and Abeta 42 to Abeta 20 ratio
Gene
rates a proprietary Amyloid Probability Score, estimating the likelihood for
Alzheimers Disease
Erythroderma
(derm, hyperplasia)
Updates
Scrotal Swelling
(urology, sx)
Updates
Infantile Hemangioma
(derm, peds)
Propranolol
is FDA approved for age 5 weeks and older
Well tolerated and very effective at facilitating
Hemangioma
involution when used in the first year of life
Start in first months of life to prevent proliferation and continue for 6 months
Dose: 1 mg/kg (max 2-3 mg/kg/dose) orally twice daily, given after feeding to prevent
Hypoglycemia
Depression Medical Management
(psych, depress)
Updates
Covid19
(lung, id)
Updates regarding Pxlovid including specific
Drug Interaction
s
Head Lice
(derm,
Parasite
)
Abametapir (Xeglyze) is another agent soon available to treat
Head Lice
pSOFA Score
(id, fever)
Added, thanks to Dr. Sourabh Jain
APACHE Score
(GI, Exam)
Updated to link to APACHE 4 Calculator, thanks to Dr. Sourabh Jain
Tirzeptatide (endo, pharm)
Tirzeptatide (
Mounjaro
) is a GLP1-
Agonist
, but also a
GIP Agonist
In combination with
Metformin
, reduces
Hemoglobin A1C
up to 2.3%
Weight loss in
Diabetes Mellitus
patients may approach 25 pound loss in 10 months
Same adverse effects and risks as with
GLP-1 Agonist
s
Seborrheic Dermatitis
(derm, dermatitis)
Updates
Collagen Supplement
(pharm, alternative)
Added
Medical Precepting
(manage, communication)
Added
Giapreza
(cv, pharm)
Updates
Methotrexate Toxicity
(rheum, pharm)
Updates
Social Media
(prevent, computer)
Updates, and a resource added to The Social Dilemma Movie
Gastrointestinal Bleeding Management
(gi, sx)
Updated intubation management thanks to Dr. Sourabh Jain
Cardiac CT Calcium Scoring
(cv, rad)
Updates
Cachexia in Cancer
(hemeonc, endo)
Updates
Updates
July 2022
Sodium Nitrite Poisoning
(er, toxin)
Added
Unknown Ingestion
(er, toxin)
Updated with precautions regarding newer combinations used in online
Suicide
kits
Cellulitis
(derm,
Bacteria
)
Updates, including
Necrotizing Fasciitis
, severe
Cellulitis
empiric regimen
Negative Pressure Wound Therapy
(surgery, procedure)
Added
Community Acquired Pneumonia
(lung, id)
Extensive updates
Monkeypox
(id, virus)
Added
Clostridiodes difficile (gi, id)
Updated
Antibiotic
coverage
Pneumococcal Vaccine
(id, immunize)
Another reminder that pneumococcal
Vaccination
has been simplified
Prevnar 20
is sufficient alone in most adults with
Pneumococcal Vaccine Indications
Herd Immunity
from
Primary Series
in children has markedly reduced invasive pneumococcus in elderly
Superior Vena Cava Syndrome
(cv, vessel)
Updates to
Superior Vena Cava Syndrome
and to
Generalized Edema Above the Diaphragm
Splenic Rupture
Spontaneous
Splenic Rupture
is seen in
Infectious Mononucleosis
(EBV) with
Splenomegaly
Spontaneous rupture accounts for 50% of
Infectious Mononucleosis
related
Splenic Rupture
cases
Preoperative Examination in Children
(surgery, exam)
Added with extensive coverage
Water Intoxication
(renal,
Sodium
)
Water Intoxication
, beer potomania,
Tea and Toast Syndrome
share a similar mechanism for
Hyponatremia
Patient with excessive hypoosmolar fluid intake (free water, beer, tea) and low solute diet (low
Sodium
intake)
Intake exceeds the renal capacity for free water excretion (50 to 100 meq/L or mOsm/L, specific gravity <1.003)
Calcium Supplementation
(renal,
Calcium
)
Updated absorption
Myasthenia Gravis
(neuro, motor)
Updates
Cerebrovascular Accident
(neuro, cv)
Updates
Finger Fracture
(ortho, hand)
Updates to
Fracture
s including avulsion
Fracture
s
Finger Dislocation (ortho, hand)
Updates
Pelvic Fracture
(ortho, hip)
Updates
Lumbar Surgery
(ortho, surgery)
Added
Laceration Repair
(surgery, derm)
Scattered updates
Regional Anesthesia
(Surgery, Pharm)
Multiple updates and revisions based on the excellent HQMedEd
Regional Anesthesia
course at HCMC
Added 5 new diagrams for added blocks
PENG Regional Anesthesia
(Surgery, Pharm)
Another method for
Regional Anesthesia
of the hip
Axillary Nerve Block
(Surgery, Pharm)
Added
Supraclavicular Brachial Plexus Block
(Surgery, Pharm)
Added
Xylazine Toxicity
(psych, cd)
Adrenergic alpha-2
Agonist
(similar to
Clonidine
,
Dexmedetomidine
) with central acting decrease in sympathetic tone
Used as a
Sedative
,
Analgesic
and centrally acting
Muscle
relaxant in veterinary medicine
Street name, "
Horse Tranquilizer
", added to injection
Drugs of Abuse
(e.g.
Fentanyl
,
Cocaine
) to enhance euphoria
Associated with
Opioid Overdose
deaths, and unresponsive to
Naloxone
Cannabinoid Hyperemesis
(psych, cd)
Capsaicin
cream may work on vanilloid receptors in
Hypothalamus
(similar to the action of a hot shower)
Apply 0.075%
Capsaicin
cream as a thin film every 4 hours until symptoms resolve
Apply cream to 15 x 25 cm or palm sized area periumbilical area using a gloved finger
Peak effect in 20-30 minutes and lasts 3 hours
Premature Ejaculation
(urology, sx)
Added
Emergency Contraception
(gyn, pharm)
Mirena
IUD (
Levonorgestrel
-releasing) has similar efficacy to Copper-T IUD for EC
Intrauterine Device
(gyn,
Contraception
)
Studies support longer duration for IUD use
Copper T-380A (
Paragard
) IUD: 10 years (studies support 12 years of use)
Mirena
: 7 year
Levonorgestrel IUD
(originally labelled for 5 years)
Depo Provera
(gyn pharm)
Self-administered
Depo Provera
Subcutaneous (SQ) dosing is off label but supported by CDC, WHO
Aspirin
(pharm,
Analgesic
)
Falling out of favor in the primary prevention of lower risk patients without
Myocardial Infarction
or stroke (NNT 250 for first CV event)
Benefits may not outweigh the risks of
GI Bleed
ing,
Hemorrhagic CVA
(NNH 200)
Insect Repellent
(id, pharm)
Updated
Agitation in Dementia
(neuro, cognitive)
Updated
PDE5 Inhibitor
(urology, pharm)
Blurred Vision
or
Vision Loss
(
Retinal Detachment
, Optic
Neuropathy
), with higher risk in atherosclerosis
Vision Loss
can be permanent and appears to occur with all
PDE5 Inhibitor
s
Incidence
may be as high as 16 in 10,000
Orexin Antagonist
(urology, pharm)
Added
Quviviq
(
Daridorexant
), another expensive sleep aid
D-Dimer Discriminatory Values in Pulmonary Embolism
(hemeonc, lab)
Added PEGeD protocol related discriminatory values
DVT Prevention in Travelers
(hemeonc, prevent)
Updates
Iritable
Bowel
Syndrome
Ibsrela
(
Tenapanor
) is another expensive agent for
Constipation
dominant iritable bowel syndrome
Soft Tissue Mass
Added
Plantar Fibromatosis
(ortho, foot)
Updates
Nodular Tenosynovitis
(ortho, hemeonc)
Added
Liposarcoma
(hemeonc,
Sarcoma
)
Added
Dermatofibrosarcoma Protuberans
(hemeonc,
Sarcoma
)
Added
Leiomyosarcoma
(hemonc,
Sarcoma
)
Added
Rhabdomyosarcoma
(hemeonc,
Sarcoma
)
Updated
Hypothyroidism
(endo,
Thyroid
)
TSH elevations are often transient in the elderly (often during non-
Thyroid
related acute conditions)
Exercise
caution when starting
Thyroid Replacement
in the elderly, and consider rechecking TSH after acute illness
Thanks to Dr. Joe Weidner for the pearl
Updates
June 2022
Pediatric Constipation
(gi, peds)
Extensive updates
Acute Radiation Syndrome
(er, toxin)
Added a thorough review of
Radiation Syndrome
First Seizure Evaluation
(neuro,
Seizure
)
Extensive updates
Pediatric CVA
(neuro, cv)
Expanded differential diagnosis
Telangiectasia
(derm, exam)
Added extensive review
Subtalar Dislocation
(ortho, foot)
Added this high energy, rare foot dislocation
Prevention of Kidney Disease Progression
(renal, prevent)
Limiting
Dietary Sodium
intake (e.g. <2300 mg/day) lowers
Blood Pressure
and decreases albuminuria
Postpartum Care
(ob, postpartum)
Reviewed
Postpartum Hemorrhage
,
Peripartum Cardiomyopathy
,
Cerebral Venous Thrombosis
,
Amniotic Fluid Embolism
,
Preeclampsia
Sexually Transmitted Infection
(id, std)
Updates
Mycoplasma Genitalium
(id, std)
Added
Intimate Partner Violence
(prevent, abuse)
Updated
Mycetoma
(derm, id)
Added
Psoriasis
(derm, hyperplasia)
Updates to management
Foreign Body Granuloma
(surgery, derm)
Added a brief summary of this complication of retained
Skin Foreign Body
Vasomotor Symptoms of Menopause
(gyn, sx, endo)
A few updates and corrections to
SNRI
s
Deep Vein Thrombosis
(hemeonc, cv)
Created a deep vein image
Post-Thrombotic Syndrome
(hemeonc, cv)
Review of topic, diagnosis, grading, management and prevention
Tendinopathy
(sports, ortho)
Updated
Peroneal Tendinopathy
,
Posterior Tibial Tendinopathy
,
Anterior Tibial Tendinopathy
Added
Ankle Anatomy
diagram (
Muscle
s and tendons)
Joint Pain
(rheum, sx)
Added additional evaluation guidance
Down Syndrome
(neuro,
Disability
)
Updates to the
Health Maintenance
of adults with
Down Syndrome
Insulin Pump
(endo, pharm)
Updates
Metabolic Syndrome
(endo, dm)
Updates
Type 2 Diabete Mellitus (endo, dm)
Indications to add
SGLT2 Inhibitor
or
GLP-1 Receptor Agonist
(which are associated with lower mortality)
Established cardiovascular disease or
Chronic Kidney Disease
(esp. SGLT Inhibitor)
Four or more
Cardiovascular Risk Factor
s
Peanut Allergen Powder
(ent, pharm)
Updates
Traveling with Medications
(id, travel)
Updates
Decubitus Ulcer Prevention
(surgery, derm)
Updates
Parkinson's Disease Management
(neuro,
Tremor
)
Updates
Spinal Cord Injured Patient
(prevent, hme)
Regular
Physical Activity
improves aerobic capacity, balance and walking ability
Improves
Activities of Daily Living
, global function,
Major Depression
and sleep quality
Prevention of Ischemic Stroke
(neuro, prevent)
Updates
Condom
(gyn,
Contraception
)
Updates
Chest XRay
(lung, rad)
A few additions including spine sign
Tobacco Cessation
(psych, cd)
Behavioral interventions are effective (with or without pharmacotherapy)
Individual or group counseling
Guaranteed financial incentives
Text message-based counseling
Hydrocarbon Ingestion
(er, toxin)
Expanded on
Hydrocarbon
definitions, examples, pathophysiology, evaluation and management
Atrial Fib
rillation
Synchronized Cardioversion
(cv, ekg)
Electrical Cardioversion results in earlier discharge compared with chemical cardioversion for CHADS 0 to 1
Thiazide Diuretic
(cv, pharm)
Chlorthalidone
is more potent than Hctz (lowers SBP 10 mmHg more)
Hctz immediate release only covers daytime
Hypertension
Lung Cancer
(lung, hemeonc)
Extensive updates to
Lung Cancer
,
Non-Small Cell Lung Cancer
,
Small Cell Lung Cancer
Also updates to
Lung Nodule
(approach changed in 2017) and
Lung Cancer
screening (approach changed in 2021)
Prostate Cancer Screening
(urology, hemeonc)
MyProstateScore (MPS) is two urinary biomarkers:
Prostate Cancer
Antigen
3 (PCA3), TMPRSS2:ERG
Gene
Fusion
Consider in patients referred for
Prostate
biopsy
Cost of $760 is not covered by
Medicare
or medicaid
COPD Pulmonary Rehabilitation
(lung, sports)
Virtual Pulmonary Rehab or Telerehabilitation (phone call, phone app, computer, video conference)
As effective as in-person rehab in reducing breathlessness and increasing walk distance in
COPD
Livedo Reticularis
(rheum, exam)
Added, with updates to
Polyarteritis Nodosa
and
Takayasu Arteritis
Lateral Canthotomy
(eye, procedure)
Updates
Hypopyon
(eye, exam)
Expanded on differential diagnosis including
Pseudohypopyon
Also Added endogenous
Bacteria
l endophthalmalitis
Macular Degeneration
VEGF Inhibitor
Ocular Implant containing Ranibizumab (Susvimo) is inserted via a small incision in pars plana and
Sclera
Similar to
VEGF Inhibitor Intravitreal Injection
s that require reservoir refill via needle only every 24 months
As effective as intravitreal injection, but with
Endophthalmitis
risk (1.7%) is higher with implants than with injection (0.5%)
Conjunctiva
l
Hemorrhage
, hyperemia ad
Iritis
are common initial adverse effects in first month
Hypertrophic Cardiomyopathy
(cv,
Myocardium
)
Extensive updates to diagnosis, evaluation, management including specific guidelines in pregnancy, athletes, pilots, truck drivers
Covid19 Monoclonal Antibody
(lung, pharm)
Bebtelovimab is a
Monoclonal Antibody
effective in omicron variants
PreHevbrio
(id, immunize)
Three
Antigen
recombinant
Hepatitis B Vaccine
indicated as a
Hepatitis B Vaccine
option in non-pregnant adults
This Tri-
Antigen
ic
Vaccine
Appears more immunogenic than other, single
Antigen
preparations
However, associated with more local pain, as well as myalgias,
Headache
,
Fatigue
than with the other preparations
As with most other Hepatiis B
Vaccine
s, administer in 3 doses at 0, 1, and 6 months
Ventricular Tachycardia
(cv, ekg)
Additional features that make
Ventricular Tachycardia
more likely than SVT with aberrancy
Right bundle branch morphology of the QRS (RSR' or "rabbit ears")
Fusion Beats (supraventricular and ventricular waves fuse to form an irregular QRS)
Intravenous Contrast for Abdominopelvic CT
(surgery, rad)
Updates
Low Back Pain Management
(ortho, l-spine)
Antispasmodics/
Muscle
relaxants once again show no benefit and increased adverse effects
Hospital Support for Lactation
(ob,
Lactation
)
Infant Carrier may increase the rate of
Breast Feeding
at 6 months
Updates
May 2022
Urethral Stricture
(urology,
Urethra
)
Added complete review including diagnosis and management
Oral Lesion
(dental, mucosa)
Updated
Aphthous Ulcer
,
Oral Candidiasis
,
Geographic Tongue
,
Hairy Tongue
,
Herpes Labialis
,
Leukoplakia
,
Torus Palatinus
,
Oral Lichen Planus
Venous Thromboembolism
(hemeonc, cv)
Extensive updates with a focus on recurrent VTE management
Added two decision rules:
HERDOO2 Model
and
Orbit Bleeding Risk Score
Also updated
Breakthrough VTE
Sleep Disorders
(psych, sleep)
Extensive updates
Sexually Transmitted Infection
(id, std)
Extensive Updates to
Sexually Transmitted Infection
, especially regarding gonorrohea and
Chlamydia
Include pharyngeal and rectal GC, Ch testing when indicated
Ulcerative Colitis
(gi, ibd)
Extensive updates
Ivabradine
(cv, pharm)
CHF agent - updated
Drug Interaction
s, adverse effects, contraindications
Cascades of Care
(manage, legal)
Extra tests beget more tests
Shingles Vaccine
(id, immune)
Shingrix
is now recommended for
Immunocompromised
patients, age >19 years
Alcoholic Hepatitis
(gi, liver)
Extensive updates
Lung Abscess
(lung, id)
Extensive updates
Near-Hanging
(er, ent)
Extensive Updates
Myocarditis
(cv, id)
Gene
ral updates to the diagnostic approach
Nasal Fracture
(ent, nose)
Updates on imaging approach (skip the xray)
Hepatitis B Vaccine
(id, immune)
Hepaitis B
Vaccine
is recommended for all unvaccinated adults ages 19 to 59 years
Fever in the Returning Traveler
(id, fever)
Extensive updates
Intraosseous Line
(er, procedure)
Added image for access sites
Analgesic Overuse Headache
(neuro,
Headache
)
A few updates
Monkshood Poisoning
(er, toxin)
Added
Tetrahydrocannabinol
(psych, cd)
Delta-8 THC is a synthetic, chemically similar to THC (delta-9), but with risk of life threatening toxicity
Myasthenia Gravis
(neuro, motor)
Updates
Tick Borne Illness
(er, derm)
Updates
Alpha Gal Reaction
(ent, allergy)
Added
Powassan Encephalitis
(neuro, id)
Added
Southern Tick Associated Rash Illness
Added
Gabapentin
(neuro, pharm)
Updates
Agitated Delirium
(psych, behavior)
Updates
Scaphoid Fracture
(ortho, wrist)
Short Arm Cast
WITHOUT thumb appears as effective as
Thumb Spica Cast
, and with better hand function while casted
Elbow Ossification Centers
(ortho, anatomy)
Added image for
Elbow Ossification Centers
(CRITOE Mnemonic)
Homeopathy
(pharm, alternative)
Solutions so dilute, they may lack even a single molecule of "active" ingredient, but could have harmful contaminants
Who knows? Not the consumer, and not the FDA or USP, since these are unregulated
Peptic Ulcer
(gi, pud)
Glycopyrolate was originally used in the 1960s for
Peptic Ulcer
s to reduce gastric secretions
However, since that time, much more effective medications are available (e.g.
H2 Blocker
s,
Proton Pump Inhibitor
s)
Yet, in 2022 Dartisla ODT was released at $500/90 tablets, a 10 fold markup over generic glycopyrolate
Avoid glycopyrolate (including Dartisla ODT) in
Peptic Ulcer Disease
(we have much better. less expensive treatments)
Fluoride Supplementation
(pharm, mineral)
Added dental varnish (had been included in
Oral Health in Children
)
Delayed Antibiotic Prescription
(pharm, id)
Example:
Acute Sinusitis
<10 days of symptoms (to start if symptoms refractory to non-
Antibiotic
s at >10-14 days)
Delayed Antibiotic Prescription
s result in decreased
Antibiotic
use, without adverse outcomes
Covid19
(lung, id)
Added AAP Return to Play guidelines for child and teen athletes following Covid 19 infection
Preparticipation Physical Evaluation
(sports, exam)
Added
Electrocardiogram
precautions
Alcohol Intoxication
(psych, cd)
Gene
ral updates
Hepatitis B Serology
(gi, lab)
Added another
Serology
interpretation table
Langerhans Cell Histiocytosis
(hemeonc, marrow)
Rare condition presenting in young children age<3 with atypical, refractory
Seborrheic Dermatitis
or
Eczema
Plenity
(endo, pharm)
Updated
Mild Closed Head Injury
(er, neuro)
I-Stat TBI Plasma detects 2 markers of intracranial injury (UCH-L1, GFAP)
May be used to risk stratify to
Head CT
Imaging in adults within 12 hours of
Closed Head Injury
with GCS 13 to 15
CT Indicated if UCH-L1 > 327 pg/ml, or GFAP >22 22 pg/ml
Test Sensitivity
97.6% for intracranial
Head Injury
and
Negative Predictive Value
99.6%
Bacterial Meningitis
(neuro, id)
Updated decision rules
Alopecia Areata
(derm, hair)
Updated
Zinc Deficiency
(pharm, minerals)
Updated
Zinc Deficiency
and
Zinc
Clinical Practice Guideline
(manage, research)
Updated with pitfalls, resources
Updates
Apri
l 2022
Sacroiliac Joint Dysfunction
(ortho, L-spine)
Extensive updates
Pediatric Murmur
(cv, exam, peds)
Extensive updates to
Heart Murmur
,
Systolic Murmur
,
Diastolic Murmur
,
Congenital Heart Disease
and
Pediatric Murmur
Prevnar 20
(id, immunize)
Pneumococcal Vaccine
recommendations by CDC have changed every few years and are confusing
Pneumococcal
Vaccination
is recommended for over age 65 years and those with risk factors
As of 2022,
Prevnar 20
ALONE replaces other
Pneumococcal Vaccine
s
If
Prevnar 13
or
Vaxneuvance
are used for conjugate
Vaccine
, then also give
Pneumovax 23
(at interval)
Telemedicine Diabetes Mellitus Evaluation
(endo, exam, dm)
Provider and nurse diabetes
Telemedicine
visits improve outcomes and glycemic control (esp. Type 2 Diabetes)
Remote
Glucose
monitoring is among the most effective
Telemedicine
strategies
Corticosteroid
(endo, pharm)
Added
Corticosteroid
tapering indications (>3 weeks of use, disease flare expected on stopping)
Also added physiology related information
Thalassemia
(hemeonc,
Hemoglobin
)
AFP Journal has an excellent review of
Thalassemia
in March 2022 issue
Article brings into focus the management and complications of
Thalassemia
based on transfusion dependent or not
Extensive updates to a topic that I feel I understand much better after reading this article
Also completed a
Hemoglobin
diagram
Fever Without Focus Management Birth to 3 Months
(id, peds)
Extensive updates to the well appearing febrile infant protocol that changed in fall of 2021
Medications in Lactation
(ob, pharm)
Updated
Medications in Lactation
and
Breast Feeding Problems for the Mother
Menstrual Cycle
(gyn, exam)
Extensive additions to the physiology of the
Menstrual Cycle
including a new diagram
Intussusception
(surgery, gi)
Updates
Monteggia Fracture
(ortho, elbow)
Do not miss the
Radial Head Dislocation
!
Added image for
Forearm Fracture
dislocations (GRUM)
Narrow Pulse Pressure
(cv, exam)
May predict circulatory collapse in
Trauma
with
Hemorrhage
Prehospital
Narrow Pulse Pressure
predicts severe
Trauma
and need for aggressive
Resuscitation
Interpret in combination with
Trauma Evaluation
and other markers (
Hypotension
,
Shock Index
)
Septic Olecranon Bursitis
(ortho, id)
Bursa Aspiration
for
Gram Stain
and culture has been historically recommended in all cases of
Septic Bursitis
However, based on new ED based study, empiric
Antibiotic
management without aspiration may be a safe and effective strategy
Health Care Associated Infection
(id, prevent)
Updates to
CAUTI
,
CRBI
, VAP, C. difficile,
Surgical Site Infection
,
Antibiotic Resistant Infection
Insulin
(endo, pharm)
Added additional information about
Insulin
U-500
Hyperparathyroidism
(endo,
Parathyroid
)
Extensive updates to
Hypercalcemia
and
Hyperparathyroidism
Also updated
Hypocalcemia
and
Hypoparathyroidism
Hypopituitarism
(endo, pituitary)
Added
CT Angiography in Gastrointestinal Bleeding
(gi, rad)
Preferred test when
Lower GI Bleed
patient cannot undergo endoscopy, with significant
Lower GI Bleed
ing
Cerebral Venous Thrombosis
(neuro, cv)
Updated risk factors, precautions, presentation, management
Cerebral Arteriovenous Malformation
(neuro, cv)
Added, and also added
Arteriovenous Malformation
Cerebral T Waves
(cv, ekg)
Associated with large
Intracranial Hemorrhage
(also seen in cerebral edema,
Ischemic CVA
,
PRES
)
Typically in precordial leads, and T Inversion may be >20 mm
May be associated with
Prolonged QT
c
Altered Level of Consciousness in Children
(neuro, peds)
Added with an extensive protocol and differential diagnosis
Pneumonia Management in Children
(id, lung)
Updates regarding
Antibiotic
selection and shorter durations (5 days)
Psychological First Aid
(psych, exam)
Added lay person intervention in
Suicidality
Buprenorphine
(pharm,
Analgesic
)
Added dental decay related adverse effects
Melatonin
(pharm, alternative)
Updates regarding safety (not recommended in pregnancy and
Lactation
), may cause
Growth Delay
in children
Updated dosing in children
Diabetic Neuropathy
(endo, neuro)
Updates on medication management
Acute Angle-Closure Glaucoma
(eye,
Glaucoma
)
Updated exam and management
Buprenorphine
(pharm,
Analgesic
)
Oral
Buprenorphine
preparations (e.g. buccal, sublingual) may increase risk of
Tooth Decay
Eczematous Dermatitis
(derm, dry)
Added new agents (monoclonal antibodies,
JAK Inhibitor
s)
Flecainide Overdose
(cv, pharm)
Reviewed toxicity findings and management
Body Packer
(er, toxin)
Additional management including
Whole Bowel Irrigation
added to protocol
Subcutaneous Hematoma Drainage
(surgery, procedure)
Added
Postoperative Oral Bleeding
(dental, mucosa)
Added based on author experiences
Limited evidence for approaches gleamed from expert opinion, including otolaryngology
Hemophilia B
(hemeonc, coags)
Updates to management
Wound Closure with Staples
(surgery, procedure)
Added
Auricular Field Block
(surgery, procedure)
Updated
Retrograde Urethrogram
(urology, procedure)
Updated
Central Cord Syndrome
(ortho, c-spine)
Updated
Spinal Epidural Abscess
(ortho, l-spine)
Spinal Epidural Abscess
is frequently misdiagnosed on initial presentation
Be alert for red flag presentations (esp. with back pain)
Unexplained fever is present in 86% of cases
Focal neurologic deficits with progressive or disabling symptoms is present in 82% of cases
Tramadol
(pharm,
Analgesic
)
Additional
Tramadol
updates (many reasons to avoid)
Read the Tox and the Hound (Tramadont)
PF Ratio
(lung, lab)
Allows interpretation of ABG
PaO2
while on
Supplemental Oxygen
Energy Metabolism
(endo, exam)
Added additional factors affecting
Energy Metabolism
Ear Canal Bleeding after Cerumen Removal
(ent, ear)
Continuous
Ear Canal Bleeding after Cerumen Removal
by ENT lead to my learning of a quick trick to control bleeding (ear wick)
Ceftazidime-Avibactam
(id, pharm)
Updates
Phosphine Toxicity
(er, toxin)
Added
Updates
March 2022
Maturity Onset Diabetes of the Young
(endo, diabetes)
MODY
accounts for 1 to 5% of
Diabetes Mellitus
cases and often misdiagnosed as Type 1 or Type 2 Diabetes
MODY
is typically
Autosomal Dominant
(3 genetic defects account for >95% of cases)
MODY
results from non-autoimmune deficient
Insulin
secretion, with
MODY
1 and
MODY
3 typically requiring treatment
MODY
1 and 3 are highly sensitive to
Sulfonylurea
s (with
Hypoglycemia
risk), which often maintain efficacy for decades
Hemoptysis
(lung, sx)
Extensive updates
Borderline Personality Disorder
(psych, behavior)
Extensive Updates
Foot Drop
(neuro, exam)
Added a page on
Foot Drop
(thanks to Dr. Wesam Khalfalla for the suggestion)
Tracheostomy Obstruction
(lung, procedure)
Updates added to precautions in
Hypoxia
management
Intranasal
Ketamine
(surgery, pharm)
Updates with sedation dosing which are 2-4 fold higher dosing than the
Analgesic
dosing
Left Ventricular Hypertrophy Related EKG Changes
(cv, ekg)
Precautions regarding
High Left Ventricular Voltage
in healthy young patients, esp. athletes (not LVH)
Gastrointestinal Metabolism
(gi, anatomy)
Extensive updates to the physiology of
Digestion
including multiple diagrams
Diagrams added for
Carbohydrate Metabolism
,
Lipid Metabolism
,
Protein Metabolism
and overall
Digestion
mechanisms
Also created diagrams related to
Glycolysis
,
Gluconeogenesis
,
Kreb Cycle
Intestinal Atresia
(gi, peds)
Added, and also updated malrotation and
Midgut Volvulus
Respiratory Physiology
(lung, anatomy)
Finally completed a diagram of
Lung Physiology
Hypothalamus
(neuro, anatomy)
Added
Hypothalamus
-Pituitary
Hormone
physiology diagram
Calcium Metabolism
(renal, lab)
Updated the
Calcium Metabolism
image to incorporate
Vitamin D
synthesis and activation
Thyroid Anatomy
(endo, anatomy)
Added
Thyroid
function diagram
Adrenal Gland
(endo, anatomy)
Added adrenal function diagram
Aldosterone
(endo, lab)
Added a topic on
Aldosterone
and mineralocortoid
Glucose Metabolism
(endo, exam)
Added diagrams for
Gluconeogenesis
(and
Ketogenesis
),
Glycolysis
and
Carbohydrate Metabolism
Sleep Problems in Children
(psych, peds)
Extensive updates, including added
Parasomnia
s
Unknown Ingestion
(er, toxin)
Extensive updates
Animal Bite
(er, derm)
Extensive Updates
Cervical Ripening
(ob, ld)
Updates to techniques
Labor Induction
(ob, ld)
Updated with
Labor Induction
indications including
Gestational age
criteria per condition
Added
Amniotomy
Nerve Agent Exposure
(er, toxin)
Updates
Sugammadex
(neuro, pharm)
Updates
Human Trafficking
(prevent, abuse)
Updates
Intracompartmental Pressure Monitor
(ortho, procedure)
Updates
Tracheal Suction
ing (er, procedure)
Updates
Fever of Unknown Origin
(id, fever)
Updates
Fluvoxamine
(psych, pharm)
Updates (due to increased adjunctive use for Covid, but mixed evidence of benefit)
Cannabinoid
Intoxication
(psych, cd)
Additional updates for accidental THC
Intoxication
in children
Inferior Shoulder Dislocation
(ortho,
Shoulder
)
Updates to management including
Shoulder
reduction of inferior dislocations
Closed Thoracic Lavage
(lung, procedure)
Added
Idiopathic Intracranial Hypertension
(neuro, csf)
Updated MRI findings
Intravenous Acetaminophen
(pharm,
Analgesic
)
IV Acetaminophen
(
Ofirmev
) has had minimal use since release in 2010; costs $30/dose compared with $0.01 for oral
Acetaminophen
Use may increase when generic for perioperative patients as well as for NPO patients as adjunctive to
NSAID
s and
Opioid
s
Updates
February 2022
Pediatric Pneumonia
(lung, id)
Consider occult
Pneumonia
in fever >5 days,
Leukocytosis
or
Abdominal Pain
Abdominal Pain
is the presenting complaint in 8.5% of patients, age 3 to 14 years old (esp age <5 years)
Vomiting
or
Diarrhea
is present in 27% of
Pediatric Pneumonia
cases
Cardiac Syncope
(cv, sx)
Cardiac cause of
Syncope
is more likely in known cardiovascular disease (e.g. CAD, CHF,
Atrial Fib
), first episode after age 35 years
Associated with no prodrome or prodromal
Chest Pain
or
Shortness of Breath
or
Cyanosis
Covid19
(lung, id)
Nirmatrelvir/
Ritonavir
(
Paxlovid
, Pfizer) is FDA emergency authorized, oral
Protease Inhibitor
Indicated in high risk outpatients started within first 5 days
Transient Global Amnesia
(neuro,
Amnesia
)
Transient inability to form new memories (
Anterograde Amnesia
) in episode lasting minutes to up to 24 hours
One probable trigger is
Valsalva Maneuver
, which appears to cause transient MRI lesions in the
Hippocampus
Vitamin D Toxicity
(pharm,
Vitamin
)
Expanded on topic
Subcutaneous Single Injection Digital Nerve Block
(surgery, pharm)
Another finger
Anesthesia
block technique
Essential Tremor
(neuro,
Tremor
)
Topiramate
is now a first-line agent in
Essential Tremor
Drug Induced
Tremor
causes was also updated
Abdominal Trauma
(er, gi)
Bowel
injury is rare (1-5%) in
Blunt Abdominal Trauma
, but easily missed when it does occur
Bowel
wall breaks and free air are seen in only a minority of bowel wall injuries
Free fluid without solid organ injury is a red flag for intraabdominal injury
Adult Intussusception
(surgery, bowel)
Rare in adults (<0.08% of cases) and associated with malignancy in 15 to 65% of cases
Bacterial Endocarditis
(cv, id)
Gene
ral Updates
Aortic Stenosis
(cv, valve)
Gene
ral Updates
Septic Bursitis
(ortho, id)
Updates
Agitated Delirium
(psych, behavior)
Updated differential of the febrile
Agitated Delirium
patient
Staphylococcal Scalded Skin Syndrome
(derm, id)
Updates
Cluster Headache
(neuro,
Headache
)
Extensive updates
Adenomyosis
(gyn,
Uterus
)
Extensive updates
Orthostatic Hypotension
(cv, exam)
Extensive updates
Pruritus
(derm, sx)
Extensive updates
Arterial Atherosclerosis
(surgery, cv)
Updated interventions for AAA,
Carotid Stenosis
,
Renal Artery Stenosis
and
Peripheral Arterial Disease
Positive Predictive Value
(prevent, epi)
Updated examples and links to calculator
Inhalation Injury
(er, environ, burn)
Gene
ral updates
Venous Thromboembolism in Pregnancy
(ob, hemeonc)
Updates
Provider Burnout
(manage, psych)
Organizational prevention strategies added
PCSK9 Small Interfering RNA
(cv, pharm)
New
Subcutaneous Injection
for severe
Hyperlipidemia
Covid19
(lung, id)
Updates related to
Paxlovid
Gastroesophageal Reflux
(gi,
Esophagus
)
Updates on PPI discontinuation
HIV PrEP
(hiv, prevent)
Updated options for management
Fertility Tracking
(gyn,
Contraception
)
Updates regarding
Urine LH
kits
Dual Antiplatelet Therapy
(hemeonc, pharm)
Status post coronary DES, use dual agents for 6 months, then
Aspirin
If high risk of bleeding (e.g.
Gastrointestinal Bleeding
), than use 3 months dual, 9 months
Clopidogrel
, then
Aspirin
daily
Updates
January 2022
Acute Aortic Occlusion
(surgery, cv)
Added
Arrhythmia Following Myocardial Infarction
(cv, ekg)
Added
Septic Arthritis
(rheum, id)
Extensive updates, including added
Prosthetic Joint Infection
Pediatric Vomiting
(gi, peds)
Extensive updates to
Pediatric Vomiting
and
Vomiting Causes in Children
Superior Mesenteric Artery Syndrome
(surgery, gi)
Added
Hepatitis C
(gi, id)
Extensive Updates
Cannabinoid
(psych, cd)
Extensive updates
Pneumonia in Children
(lung, peds)
Updates
Unprovoked Seizure in Children
(neuro,
Seizure
)
Added
High Sensitivity Troponin
(cv, lab)
Added protocol for
High Sensitivity Troponin
I
Thyroiditis
(endo,
Thyroid
)
Updates
Color Blindness
(eye,
Vision
)
Added
Covid19
Vaccine
(id, immunize)
Pfizer Covid19
Vaccine
approved for ages 5-12 years. Updated dosing
Covid19
(lung, id)
Updated
Venous Thromboembolism
Prophylaxis in
Covid19
Prevnar
(id, immunize)
Prevnar 20
is available for adults, pending approval in children
Dry Eye
s (eye, sx)
Intranasal
Varenicline
(Tyrvaya) is a approved intranasally at $600/month for modest effect on
Dry Eye
s
Subcutaneous Injection
(er, procedure)
Updates
Intramuscular Injection
(er, procedure)
Updates
Seasonal Effective Disorder (psych, depression)
Updates
Eczematous Dermatitis
(derm, dry)
Opzelura (
Ruxolitinib
) is a a topical
JAK Inhibitor
approved for refractory mild to moderate
Eczema
Isotretinoin
(derm, pharm)
Updated
Citalopram Overdose
(psych, pharm)
Updated
Citalopram
and
SSRI
ovderose
Presbyopia
(eye,
Vision
)
Added topic as well as
Vuity
(
Pilocarpine
)
Septic Joint
(rheum, id)
Updates
Patella
Dislocation (ortho, knee)
Relocation updates
Ulnar Nerve Block
(surgery, pharm)
Updates
Aortoenteric Fistula
(surgery, cv)
Added
Fallopian Tube Torsion
(gyn, ovary)
Rare, isolated tube torsion added
Subarachnoid Hemorrhage
(neuro, cv)
Updates to diagnostic rules
Tube Thoracostomy
(lung, procedure)
Updates
Nutritional Support
(pharm, nutrition)
Reviewed
Enteral Nutrition
,
Parenteral
nutrition
Isoniazid Overdose
(lung, pharm)
Added
Intravenous
Angiotensin
(cv, pharm)
New agent for refractory
Hypotension
Patient Education
(manage, general)
Updated, including misinformation
Benign Prostatic Hyperplasia
(urology,
Prostate
)
Updated management
Lybalvi
(psych, pharm)
Olanzapine
/Samidorphan (
Lybalvi
) is released in 2021 at $1400/month
Samidorphan is a
Naltrexone
derivative added to reduce weight gain that typically occurs with
Olanzapine
Marginal efficacy for cost (other strategies to reduce weight gain are preferred)
Prostate Cancer Management
(urology, hemeonc)
Reviewed
Prostate Cancer
hormonal management
Vaping
(psych, cd)
Updates
Turmeric
(pharm, alternative)
Updates
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