Chronic Low Back Pain: What does and does not work (according to current evidence)

DOES WORK: Keeping moving Physical therapy or manipulation therapies Acupuncture, tai chi (clinician should emphasize possible benefits - likely enhances the placebo effect!) NSAIDs - lowest effective dose for shortest period - 1st line pharmacotherapy Can try APAP in those with NSAID contraindications, but unlikely to help Duloxetine (other SNRIs may work, but evidence lacking)… Continue reading Chronic Low Back Pain: What does and does not work (according to current evidence)

Antibiotics in Pregnancy

OK penicillins cephalosporins clindamycin erythromycin azithromycin SMX/TMP in SECOND TRIMESTER ONLY Avoid TMP in 1st trimester (folate antagonist) Avoid SMX in 3rd trimester (kernicterus risk) nitrofurantoin  Avoid in last month (risk of hemolytic anemia) CAUTION nitrofurantoin  small risk, but short courses (e.g., BV, trich) likely OK doxycycline likely OK in short courses NO fluoroquinolones tetracyclines… Continue reading Antibiotics in Pregnancy

Heparin-Induced Thrombocytopenia – Stuart

HIT occurs in 5% of patients exposed to heparin. Etiology:  Autoantibody to PF4-heparin complex. More common with UFH, in women, and with surgery. Thrombocytopenia is noted in 90%, thrombosis in 50%. Dx:  Lab:  HIT antibody testing:  PF4 antibody, IgG Clinical Dx:  Four T Score: 4 T's score [From UpToDate, 4/21/17]:  Calculating the score — The 4 T's… Continue reading Heparin-Induced Thrombocytopenia – Stuart

Tenets of Play Therapy for Difficult Patients – Hughes

Emotionally activated patients:  unmet childhood needs, pts will repeat themselves and their behaviors, result of trauma in childhood that resulted in failed development of coping skills in certain situations. Key skills: Structuring Skill: Setting the tone for the visit.  "I've got about 10 minutes, but I want to address your concerns..." Guides pts to understand… Continue reading Tenets of Play Therapy for Difficult Patients – Hughes

Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

ITP is an acquired disorder of platelets:  consider as either increased destruction or decreased production. Classified as primary (a dx of exclusion) vs secondary. Etiology:  Caused by anti-platelet IgG directed against membrane proteins of the platelets. Inciting events:  infection vs immune alteration.. Incidence:  highest in children, and increased incidence with increased age in adult. DDx:… Continue reading Idiopathic Thrombocytopenic Purpura (ITP) – Kaufman

Gout – Treatment Guidelines

(BMJ)—A committee of experts w/ experience in gout agreed upon potential targets and outcomes, which was the basis for the systematic literature search. The expert group developed 9 treat-to-target recommendations: 1. Serum urate must be measured regularly and urate-lowering tx should be adjusted to attain the therapeutic target. 2. Serum urate level <6 mg/dL should… Continue reading Gout – Treatment Guidelines

Evaluation and EKG Findings with Palpitations – Primary Care RAP

Copied from Primary Care RAP March podcast - an excellent overview of the workup and "red flags" on EKG. Palpitations are a common symptom seen in the outpatient setting. While most are benign, it is important to rule out more serious and potentially deadly causes. A family history of sudden cardiac death and certain EKG… Continue reading Evaluation and EKG Findings with Palpitations – Primary Care RAP