new trends

Question 1

Screening for abdominal aortic aneurysm (AAA)

Answer 1

• Screening did not decrease AAA-related or all-cause of mortality in women
• no significant reduction

Question 2

screening for lung cancer

Answer 2

• recommends annual low dose CT scan for high risk adults (30 packs a year) smoking or current smoker
• quit smoking within the last 15 years
• age 55-80 years older

Question 3

acid suppression and pneumonia

Answer 3

• association between proton pump inhibitor (PPI) and community acquired pneumonia (CAP) (may or may not still be true)
• initiation of NSAIDS - 6 months follow up.

Question 4

blood pressure management in the acute phase of ischemic stroke

Answer 4

• long term antihypertensive therapy is known to reduce the risk of recurrent stroke
• management in the acute phase of stroke is controversial
• lack of an observed benefit from aggressive BP control
• current approach to avoid excessive lowering within first 24 hours.

Question 5

Vitamin E supplementation

Answer 5

• used of antioxidants in patients with Alzheimer dementia is questioned
• a slower time to functional decline compared to placebo
• best results seen in mild to moderate AD
• no studies show a improvement in cognitive function

Question 6

Cardiac resynchronization in mild heart failure

Answer 6

• CRT with defibrillator vs implantable cardioverter defibrillator alone (controversial)
• in patients with LBBB using the implantable cardioverter mortality was reduced by 29%
• increase in mortality seen when using the CRT with a defibrillator

Question 7

Geriatric trauma

Answer 7

• more susceptible to injury from minor mechanisms and less able to compensate from any injury
• multiple medications some may blunt the response to the physiologic stress of trauma and increase the risk of complications
• falls and MVA (motor vehicle accidents) most common cause of injury

Question 8

under-triage

Answer 8

• over the age of 70 evaluated at a trauma center
• CDC calls for transfer to a trauma center for anyone over 65 with a BP less than 110 systolic
• a pulse of 90+ considered tachycardia
• high index of suspicion
• If you fall off a height equal to the person height than refer to trauma center.

Question 9

airway and breathig in trauma

Answer 9

• look for airway anomalies
• limited mouth opening
• dentures
• limited respiratory reserve (10 breaths per minute > risk of death)
• rapid sequence intubation meds reduced to avoid risk of cardiovascular depression

Question 10

circulation

Answer 10

• what are the normal vital signs in the elderly? (not same as younger person)
• recognizing early shock is more difficult
• remember baseline hypertension may contribute to a false sense of comfort
• better use of ultrasound