Hospitalistbloggen

Road to choosing wisely in Internal Medicine

Kort och gott om VTE

Ref: bl.a. JE, Lipus-föreläsn, Pfizer Dat: 210428 Recidiv Recidivrisk för oprovocerade proximala DVT 10% första året, därefter kumulativt 5% per år. Vid provocerande faktorer: recidiv <3% efter avslutad behandling. Gravida får DVT i vä ben 80% av fallen pga anatomi. V. Iliaca korsas av A.Iliaca i kombination med stor uterus -> kompression och minskat flöde. […]

Reverse Valsalva SVT

Ref: Journalfeed & The reverse vagal manoeuvre: A new tool for treatment of supraventricular tachycardia? Am J Emerg Med. 2021 Mar;41:66-69. doi: 10.1016/j.ajem.2020.12.061. Epub 2020 Dec 26. New ’Reverse’ Valsalva for SVT.Case report series.Exhale. Pinch Nose and tightly close mouth. Inhale against resistance for 10s.Relief.10/11 patients experienced relief of SVT after this manoeuvre. See Figure 1 […]

D-dimer for VTE in CoVID

Ref: Journalfeed. Can we trust D-dimer for VTE in CoVID? Multicenter retrospective observational study, n=1158.CTPA + D-dimerD-dimer within 24hrs of CTPA (not always prior to)For CoVID+: Sens 100% (ie. all with d-dim>cutoff +PE), spec 11.9%. NPV 100%.CoViD-: sens 97.6%, spec 14.4%, NPV 98.3%.Suggested CoVID-adjusted cutoffs for D-dimer: 0.5mg/L -> 0.67mg/L. Maintained NPV 100%, while specificity […]

Palliative Care Tips

Ref: JR, spec. Palliativmedicin Set an agenda with the patient. Get a good start: Ask the patient to introduce the agenda. ”What do you want to take away from your visit today?” Allow and help the patient to pinpoint (ie prioritise) the timeframe to go over the complete visit agenda. Ask: Anything else? Again, and […]

Effective learning

Ref: Jason Avila, 5minSono We remember 20% of what we hear. To effectively learn, we need a strong foundation. To have an idea before acquiring associations. Do not multitask. Catch key concepts. Dont take notes on everything. Be engaged. Link past applications to current reality. Summarize for cooldown and follow-up. ”The ability to simplify means […]