What's New | Decker

Curtis Wittmann, MD

A patient with posttraumatic stress disorder (PTSD) is more likely to initially present for treatment in a medical, rather than mental health, setting; however, primary care physicians recognize symptoms of PTSD in these patients only approximately 50% of the time, and often do not make the diagnosis. Patients presenting to the emergency department for physical trauma are at risk, as are combat veterans and victims of rape or domestic violence. In addition, patients undergoing frightening, painful or life-threatening medical illnesses or procedures may develop PTSD. The provision of support and information about PTSD to patients in the emergency department may enable early recognition of the symptoms and may prevent the development of full-blown PTSD.

Anne E. Dixon, MA, BMBCH, Haitham Nsour, MBBS

ATS guidelines for exercise-induced bronchoconstriction, asthma in the elderly, and asthma in the workplace
ERS/ATS guideline for severe asthma discusses pharmacologic modalities of asthma management and bronchial thermoplasty.
2020 GINA practice guidelines no longer recommend treatment with SABA alone, without inhaled ICS. Recommend that all adults and adolescents with asthma should receive ICS-containing controller treatment.
2020 NAEPP practice guidelines delineating optimal treatment steps in adolescents and adults with asthma. This includes bronchial thermoplasty and immunotherapy.

Paige Armstrong, MD, MHS, Hamid Shokoohi, MD, MPH, RDMS, RDCS

The importance of prompt administration of intravenous fluids and vasoactive medications (norepinephrine or dopamine as the first choice) and the limitations of protocol-based therapy, as guided by recent evidence, should be emphasized.
There is significant controversy surrounding Early Goal-Directed Therapy (EGDT) in the management of severe sepsis and septic shock. Recently, a few, large, multicenter randomized trials, including ProCESS (Protocolized Care for Early Septic Shock), ARISE (Australasian Resuscitation in Sepsis Evaluation), and ProMISe (Protocolised Management In Sepsis) failed to provide similar conclusive supporting evidences.

Endovascular treatment of acute ischemic stroke (AIS) enables access to occluded intracranial vessels for local administration of thrombolytics, mechanical embolectomy, and/or angioplasty. There are currently four mechanical devices cleared by the Food and Drug Administration (FDA) for recanalization of arterial occlusion in patients with AIS; however, despite being cleared by the FDA, none of these devices have an FDA clinical indication due to the need for randomized comparison with medical therapy devices. Endovascular interventions are extremely time dependent, and reduced time from symptom onset to reperfusion is highly correlated with better clinical outcomes.
CTA with CT perfusion or MRA with diffusion-weighted MRI with or without MR perfusion is recommended for certain patients (2019 AHA/ASA recommendation on head imaging).
2019 AHA/ASA updates on IV alteplase indications and management in acute ischemic stroke patients.

Anne E. Dixon, MA, BMBCH, Haitham Nsour, MBBS

ATS guidelines for exercise-induced bronchoconstriction, asthma in the elderly, and asthma in the workplace
ERS/ATS guideline for severe asthma discusses pharmacologic modalities of asthma management and bronchial thermoplasty.
2020 GINA practice guidelines no longer recommend treatment with SABA alone, without inhaled ICS. Recommend that all adults and adolescents with asthma should receive ICS-containing controller treatment.
2020 NAEPP practice guidelines delineating optimal treatment steps in adolescents and adults with asthma. This includes bronchial thermoplasty and immunotherapy.

Status epilepticus has a distinct pathophysiology that remains poorly understood; interestingly, in animal models, many of the basic underlying mechanisms appear to be common regardless of how seizures are initiated. A single seizure is transformed into a self-perpetuating and pharmacoresistant disorder through a cascade of extrinsic signaling followed by intrinsic nuclear events.
Detailed treatment approaches for status epilepticus, delineating first-line, second-line, and third-line antiepileptic drugs.
STESS prognostication scores primarily being used for research purposes but may have indication in clinical settings.

New definitions of hypertension have been established. Normal blood pressure is SBP < 120 mm Hg and DBP < 80 mm Hg. Elevated blood pressure is defined as SBP 120-129 mm Hg and DBP < 80 mm Hg. Stage 1 hypertension is defined as SBP 130-139 mm Hg or DBP 80-89 mm Hg, and stage 2 hypertension is defined as SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg.
The ATACH-2 trial showed that intensive blood pressure lowering in patients with intracranial hemorrhage leads to increased adverse events without substantial benefit.
ENCHANTED study did not show benefit in intensive blood pressure reduction in patients with acute ischemic stroke who have received intravenous thrombolysis.

Societal and Psychiatric Conditions