Is IV olanzapine ready for prime time? This boils down to a choice of the devil that we know (haloperidol) versus the devil that we don’t entirely know (olanzapine). IV olanzapine is newer, so it is possible that additional side effects may emerge over time. However, we already know that there are significant problems with IV haloperidol.
Controlled thrombolysis using a slow 25-mg alteplase infusion with protocoled monitoring might offer patients the benefit of lytic therapy with an extremely low risk of severe hemorrhage.
Ultrasound-assisted catheter-directed thrombolysis is increasingly popular for submassive PE. Unfortunately, the actual mechanism of action of this therapy remains unclear.
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.