A Budding Emergencist
Monday, June 25, 2007
  I'M BACK!

Back in action, folks...was really overwhelmed in March, couldn't post.

Good news--Got a new job; as a new emergency medicine intern at a good sized hospital, that's an excellent program, old (by ER standards), and with a lot of institutional memory and experience. Bad news is I'll probably have to move, leaving my beloved apartment, but the program is that good, that I can leave the apartment behind with nary a tear.

Continue the progressive march to the glorious future, comrades!

And for some ER news, as many of you probably know, new guidelines for prophylaxis for infective endocarditis have been published by the AHA, and the good news is the number of people at risk for IE is much fewer than previously thought. The guidelines therefore are much more restrictive than previously, saving a lot of antibiotic prescriptions and preventing antibiotic-associated complications like C. dificile colitis, anaphylaxis, tachyphylaxis, and antibiotic resistance--here's a synopsis...

New guidelines regarding antibiotics to prevent infective endocarditis

The American Heart Association recently updated its guidelines regarding which patients should take a precautionary antibiotic to prevent infective endocarditis (IE) before a trip to the dentist.

The guidelines, published in Circulation: Journal of the American Heart Association, are based on a growing body of scientific evidence that shows that, for most people, the risks of taking prophylaxis antibiotics for certain procedures outweigh the benefits. These guidelines represent a major change in philosophy.

The new guidelines show taking preventive antibiotics is not necessary for most people and, in fact, might create more harm than good. Unnecessary use of antibiotics could cause allergic reactions and dangerous antibiotic resistance.

Only the people at greatest risk of bad outcomes from infective endocarditis — an infection of the heart's inner lining or the heart valves — should receive short-term preventive antibiotics before common, routine dental and medical procedures.

Patients at the greatest danger of bad outcomes from IE and for whom preventive antibiotics are worth the risks include those with:

artificial heart valves
a history of having had IE
certain specific, serious congenital (present from birth) heart conditions, including:
- unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits

- a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter interventions, during the first six months after the procedure

-any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or prosthetic device

a cardiac transplant which develops a problem in a heart valve.

P.S. all photos and pictures will now be created by yours truly to avoid copyright infringement.

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Emergency medicine, from the beginning of a new doctor's career.

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Walk softly and carry a big vocabulary. Don't be inhuman. Find and greet God in every person you meet. The patient is the one with the disease. Do not get distracted. Charity begins at home. Do good and be happy. Don't just do something, stand still. Wear sunscreen. Don't get anyone pregnant, and don't go to jail, young man. Budget your luxuries first. You don't know what you don't know. People like learning, they just don't like being taught. When in doubt, go out. When life gives you lemons, make lemonade. Honey attracts more flies than vinegar.

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