A recap from #SHM #Converge24 discussing heart failure, GI bleeds, sepsis, critical care updates, hospital medicine, oncologic emergencies, pneumonia, COPD, transitions of care, vulnerable populations, AI, and more. Topics include POCUS, high-value medical education, molecular testing, periop updates, oral vs IV antibiotics, palliative care, and more!
IV hydrocortisone reduces mortality in severe CAP patients
Aspirin shows higher DVT rates post-operatively
Transient A-Fib patients benefit from IV hydrocortisone
Conservative approach advised for inpatient hypertension
Deep dives
Cape Cod: Study on Steroids in Pneumonia
The Cape Cod study examined the use of steroids in severe community-acquired pneumonia (CAP), focusing on patients who were intubated or on advanced oxygen devices. The study found lower intubation rates, reduced pressor use, and lower mortality with IV hydrocortisone compared to placebo.
Prevent Clot Trial: Aspirin vs. Enoxaparin for Post-Op DVT Prophylaxis
The Prevent Clot trial compared aspirin and enoxaparin for DVT prophylaxis post-operatively and found no difference in all-cause mortality or bleeding risk. However, aspirin had higher DVT rates. The study mostly included young, healthy patients with traumatic fractures.
AFOT Study: Transient A-Fib Management
The AFOT study focused on transient atrial fibrillation in hospitalized patients, observing increased A-Fib rates over 12 months. Patients with transient A-Fib had lower intubation rates, reduced pressor need, and lower mortality with IV hydrocortisone compared to placebo and no significant side effects.
Management of Inpatient Hypertension in Non-Cardiac Patients
The session emphasized a conservative approach to managing inpatient hypertension in non-cardiac patients, recommending to avoid aggressive treatment. Use of oral medications and avoiding IV therapy resulted in fewer risks and better outcomes.
Inpatient Hypertension Management: Do Not Aggressively Treat
The session advised against aggressive management of inpatient hypertension in non-cardiac patients, recommending a conservative approach to avoid adverse outcomes. Oral medications over IV therapy yielded better results and reduced risks.
Update in ARDS Diagnosis and Management
The podcast discusses updates in ARDS diagnosis, including a more inclusive definition from May 2023 that extends to patients not intubated but exhibiting characteristic bilateral infiltrates. It allows POCUS to diagnose pulmonary infiltrates in acute hypoxemic respiratory patients more promptly. Additionally, ATS recommendations now conditionally support the use of steroids in ARDS, presenting different perspectives compared to European guidelines.
Insights on Iron Deficiency Anemia and Palliative Care
The podcast covers the importance of aggressive iron deficiency treatment, especially considering IV repletion for hospitalized patients with anemia. It also debunks common myths about IV iron therapy, highlighting the complement-mediated reactions it induces. In the segment on palliative care, the significance of considering methylphenidates for apathetic patients, involving families in goals of care conversations, and utilizing prognostication tools for patients with dementia are emphasized for better end-of-life care.
We recap the top pearls for the hospitalist from #SHM #Converge24 covering discussions on heart failure, gastrointestinal bleeds, sepsis, updates in critical care, updates in hospital medicine, oncologic emergencies, pneumonia, COPD, transitions of care, vulnerable populations, AI, and more!
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