Resultados de Búsqueda

Choosing Wisely ® : Things we do for no reason

Society of Hospital Medicine

For most hemodynamically stable patients, echocardiographic findings will not enhance prognostication and/or have a therapeutic impact. The following four reasons explain why echocardiography adds little value to the care of these patients. Phenotypic expression of RVD varies from asymptomatic, despite abnormalities on diagnostic testing, to obstructive shock. Unfortunately, available prognostic models classify echocardiographic RVD in a binary fashion (present/absent) whereas RVD exists on a ...

Choosing Wisely ® : Things we do for no reason

Haber L. J. Hosp. Med. 2019 October;14(10):633-635.

As with all pain, multimodal pain management should be provided with adjunctive medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, neuropathic agents, topical analgesics, and regional anesthesia. Make plans collaboratively with the patient and outpatient provider, and communicate medication changes and plan at discharge.

Choosing Wisely ® : Things we do for no reason

Haber L. J. Hosp. Med. 2019 October;14(10):633-635.

Despite buprenorphine’s high affinity at the mu receptor, additional receptors remain available for full opioid agonists to bind and activate, providing effective pain relief even in patients using buprenorphine. Studies in this patient population have found that patients receiving buprenorphine may require higher doses of short-acting opioids to achieve adequate analgesia, but they experience similar pain control, lengths of stay, and functional outcomes to controls. Ana make plans ...

Choosing Wisely ® : Things we do for no reason

Haber L. J. Hosp. Med. 2019 October;14(10):633-635.

Evolving understanding of buprenorphine pharmacology and the absence of high-quality evidence has resulted in providers holding buprenorphine in the setting of acute pain. For patients on buprenorphine admitted to the hospital with anticipated or unanticipated acute pain needs, hospitalists should continue buprenorphine. Continuation of buprenorphine meets a patient’s baseline opioid requirement. Providers may consider holding buprenorphine if a patient with opioid use disorder has not been ...

Choosing Wisely ® : Things we do for no reason

Society of Hospital Medicine

Echocardiography is a common method for evaluating RVD, and echocardiographic RVD confers an increased risk of adverse outcomes in PE.10-12 In the earliest meta-analysis to evaluate this association, Sanchez et al. combined data from five studies that included 623 patients from emergency room and inpatient settings. They found that echocardiographic RVD conferred an unadjusted relative risk for short-term mortality of 2.53 (95%CI 1.17-5.50).12 A subsequent meta-analysis by Cho et al. pooled ...