What's New

Blunt Cerebrovascular Injuries

    • Multislice (> 64 slice) computed tomographic angiography is the routine imaging test performed to identify blunt cerebrovascular injury (BCVI).
    • With noninvasive imaging used for BCVI identification, screening criteria have recently been expanded.
    • Antithrombotic treatment almost universally prevents BCVI-related stroke.
    • Endovascular therapy for BCVI should be reserved for those patients who are markedly symptomatic from their injury or have an enlarging pseudoaneurysm on repeat imaging.

Mistreatment of Elders

    Elder mistreatment affects a considerable proportion of individuals older than 60 to 65 years of age and may include intentional abuse (physical, sexual, emotional, or financial) and neglect. As the proportion of the population that is older than 65 years of age increases, elder mistreatment will become an increasingly common issue. Only a minority of cases of elder abuse are reported; thus, an interview with the patient should be conducted in private if elder mistreatment is suspected. Patient risk factors for elder mistreatment include cognitive or behavioral impairment, poor physical health, and poor social supports.

Headache

    • Targeting calcitonin gene related peptide can improve migraine pain
    • Greater occipital nerve blocks may alleviate migraine acutely
    • Clinical decision rules can be used to exclude subarachnoid hemorrhage

Gastrointestinal Bleeding

    • Patients with gastrointestinal bleeding are critically ill. It is imperative to obtain early expert consultation and definitive care while resuscitation and stabilization begin; consults may include Gastroenterology, Surgery, and Interventional Radiology.
    • Blood transfusions are indicated for patients with hemoglobin < 7 g/dL or < 9 g/dL if there is evidence of end-organ ischemia.
    • Evidence-based clinical risk scores such as the Blatchford and Rockall scores can guide disposition decisions.

Back Pain and Common Musculoskeletal Problems

    • 2018 AAFP Key Recommendations for Heel Pain
    • 2017 AAFP Practice Guidelines – Low Back Pain: Noninvasive Management
    • 2015 AAFP Key Recommendations for Corticosteroid Injections – Common Musculoskeletal Conditions

Epilepsy and Related Disorders

    • Brain imaging has made significant progress in recent years and is a cornerstone of diagnosis and characterization of epilepsy.
    • The diagnosis and management of psychogenic non-epileptic seizures has significantly evolved in recent years.

Treatment of Unhealthy Alcohol Use

    • Treatment of unhealthy alcohol use, including mild-moderate AUD, can be initiated in primary care.
    • The anticonvulsant, gabapentin, is a viable alternative to benzodiazepines for treating outpatient alcohol withdrawal in select patients.
    • New evidence strongly supports the use of disulfiram for AUD when abstinence is the goal.
    • Although not FDA approved, gabapentin and topiramate are effective options for treating AUD.

Treatment of Unhealthy Alcohol Use

    • Treatment of unhealthy alcohol use, including mild-moderate AUD, can be initiated in primary care.
    • The anticonvulsant, gabapentin, is a viable alternative to benzodiazepines for treating outpatient alcohol withdrawal in select patients.
    • New evidence strongly supports the use of disulfiram for AUD when abstinence is the goal.
    • Although not FDA approved, gabapentin and topiramate are effective options for treating AUD.
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