Guidelines Issued for Antibiotic Prophylaxis with Implanted Heart Devices
Posted by: admin on: July 28, 2011
- Dental patients should not take prophylactic antibiotics simply because they have pacemakers or implanted defibrillators, according to a new statement from the American Heart Association (AHA).
- Although 2007 guidelines already exclude these patients from the list of those who need prophylactic antibiotics to prevent endocarditis, the AHA wanted to emphasize this point because many physicians are ignoring these guidelines, and because an increasing rate of infections related to the devices has raised concerns, coauthor Peter Lockhart, DDS, told Medscape Medical News.
- Dr. Lockhart, chair of the Department of Oral Medicine at Carolinas Medical Center in Charlotte, North Carolina, estimates that dentists are unnecessarily prescribing antibiotics to millions of patients with implanted devices and many other conditions. There is no evidence that antibiotics can prevent infections of implanted devices caused by dental procedures, he said, but the antibiotics may cause allergic reactions and create resistant strains of bacteria. “There are deaths due to use of antibiotics,” said Dr. Lockhart.
- According to the statement, prescription antibiotics would cost more than $80 million in the United States each year if given for all the cardiovascular conditions that might lead to infection.
Do Not Resuscitate and the need for a central line.
Posted by: admin on: July 27, 2011
- Just the other day I was called to see a patient coming up to the Intensive Care Unit with a diagnosis of pneumonia. Upon my arrival the patient is “hanging in there” with the blood pressure in the 60’ and 70’s systolic. The patient is in sepsis and septic shock. Early intravenous antibiotics and aggressive resuscitation is what this patient needs right now. Per the ER report he had already been given three liters of intravenous fluids with the blood pressure barely budging.
- The patient needs a central venous catheter so that the vasoactive medications (vasopressors) could be given to maintain his blood pressure. The patient was, indeed, DNR (Do Not Resuscitate) which means no aggressive treatment like mechanical ventilation or chest compression in case of a cardiac arrest. So, where do you draw the line between treatment, aggressive treatment and resuscitation?
- There is no easy answer. It all depends on individual circumstances. Thus, there is a great deal of confusion among the general public and even health care professionals about this.
Guidelines say X-rays, scans unnecessary to diagnose most lower back pain
Posted by: admin on: July 27, 2011
Guidelines say skip x-rays for lower back pain
- Imaging scans to diagnose lower back pain are unnecessary in most cases and may do more harm than good, the American College of Physicians stated in new practice guidelines.
- Routinely ordering X-rays and CT or MRI scans drives up health care costs and does not help resolve the problem, the college’s “best practice advice” guidelines say.
- Most lower back pain is caused by strain on bones, muscles and ligaments. It can be treated with over-the-counter painkillers and usually abates within a few days, said an author of the practice guidelines, Dr. Amir Qaseem, director of clinical policy in medical education at the college. Read the rest of this entry »
A-B-C is for babies; now it’s C-A-B!
Posted by: admin on: July 27, 2011
It used to be following your ABC’s: airway, breathing and chest compressions. Now, Compressions come first, only then do you focus on Airway and Breathing. The only exception to the rule will be newborn babies, but everyone else whether it’s infant CPR, child CPR or adult CPR will get chest compressions before you worry about the airway.
- The key to saving a cardiac arrest victim is action, not assessment.
- Trust your gut. If you have to hold your cheek over the victim’s mouth and carefully try to detect a puff of air, it’s a pretty good bet she’s not breathing very well, if at all.
- Push a little harder push at least 2 inches deep on the chest for adult CPR.
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