Early in my training I had a few comatose meningitis patients. They were admitted, given antibiotics, and supported on a ventilator. They died. For a while, I believed that this condition was fairly hopeless. Then I encountered a comatose young man with meningitis due to adjacent mastoiditis. His lumbar puncture opening pressure was ~50cm. Following mastoidectomy and temporary placement of a lumbar drain, he recovered. Since then, I have been increasingly aggressive about managing this. Some patients have responded surprisingly well.
Traditionally, coagulation management in patients with cirrhosis has focused largely on using large volumes of FFP to decrease the INR. However, recent evidence indicates that INR prolongation in these patients is nonspecific and that FFP usually isn’t helpful.
Routinely obtaining an ABG or VBG is widely recommended, for example in both American and British guidelines. Why? Is this helping our patients, or is it something that we do out of a sense of habit or obligation?
Introduction . It has long been known that some macrolides (e.g. erythromycin) cause torsade de pointes. However, azithromycin has a much lower affinity for cardiac potassium channels than erythromycin, so it has less effect on the heart. For many years it was believed that azithromycin lacked cardiac toxicity. . Controversy was sparked in 2012 when […]
. Background: Publication bias . Over the last several years, publication bias has received a considerable amount of attention. In its most blatant form, this is when a drug company sponsors several trials, but only publishes the trials which yeild positive results. Growing awareness of this problem has led to the development of trial registries, […]