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Hospital Medicine   

Questions discussed in this category

What is your approach to managing concurrent severe SIADH and large-volume malignant ascites when aggressive volume removal appears to exacerbate both symptoms and hyponatremia?
For example, would you consider alternatives to paracentesis (Denver shunt placement, CART therapy, or permanent tunneled catheters) that might better...
1 Answer available
How do you determine whether to limit volume removal during therapeutic paracentesis in a patient without acute or chronic kidney disease?
1 Answer available
How long after a motor vehicle accident would you expect symptoms including memory loss, hypersomnia, and mood changes to be attributable to the accident?
Traumatic brain injury 
1 Answer available
What workup is sufficient to determine if an aortic aneurysm is "mycotic/infectious" or not, in that you would not prescribe empiric antibiotic therapy?
1 Answer available
Would you consider giving thrombolytic therapy for patients with acute vision loss concerning for CRAO based on history and within the window before any ophthalmological assessment and confirmation?
Would your approach differ through telemedicine for small ERs without access to onsite ophthalmology or neurology? 
3 Answers available
When do you consider using stimulants in patients with cognitive impairments secondary to traumatic brain injury?
1 Answer available
At what point should you consider deactivating ICDs or implanted pacemakers in patients nearing the end of life but not imminently dying?
Should we consider this as a unique point during goal of care discussions, separate from code status, comfort measures only, etc.?
1 Answer available
When do you consider using aspirin 81 mg PO BID for VTE prophylaxis over other agents in patients with a fracture, considering recent trial data?
O'Toole et al., PMID 36652352
1 Answer available
Under what circumstances do you recommend POCUS guidance for lumbar puncture?
1 Answer available
Would you recommend imaging of the brain and lungs to investigate potential disseminated disease in a recent heart transplant patient with a skin nodule that grew Rhizopus?
1 Answer available
Which biomarkers or diagnostic tools do you prioritize to support the decision to start antifungal treatment in septic patients with no clear source of infection but at high risk for fungal infections?
4 Answers available
What is your preferred anticoagulation/antiplatelet regimen for younger patients presenting with ACS, found to have an acute thrombotic event requiring aspiration thrombectomy without need for stent deployment?
2 Answers available
How do you use cardiac POCUS to potentially defer formal echocardiogram in patients presenting with an acute pulmonary embolism?
1 Answer available
How do you recommend counseling patients on the prognosis of advanced cancer as a generalist who is not highly specialized in cancer literature or cancer-directed therapies?
1 Answer available
How do you decide whether to use lung POCUS versus CT as the next step when a chest X-ray is equivocal for pneumonia?
3 Answers available
What is your approach during DCCV if you have an obese patient with atrial fibrillation refractory to up to 3, 360 J shocks?
Would you then opt for double vector DCCV to deliver 2, 360J shocks simultaneously, and/or bolus with amiodarone? 
8 Answers available
How do you use IVC collapsibility on POCUS to inform decisions for managing hypotension?
1 Answer available
What is your approach to secondary prophylaxis for C difficile infection during concomitant antibiotic use in a patient with a history of C difficile infection?
1 Answer available
When starting stress dose steroids for patient with primary adrenal insufficiency, how do you decide whether to start hydrocortisone 100 mg every 8 hours versus 50 mg every 6 hours?
1 Answer available
Do you routinely continue dual antibiotic coverage or de-escalate to monotherapy based on peritoneal fluid culture sensitivities in patients with relapsing pseudomonas aeruginosa peritoneal dialysis peritonitis after peritoneal catheter removal?
1 Answer available
Would you recommend starting tolvaptan at 7.5 mg per day, which is half the typical starting dose, to reduce the risk of overcorrection in an inpatient with SIADH and a serum sodium level of 122 mEq/L?
2 Answers available
Regarding CVST, what protocol of heparin dosing do you regularly use and does it change depending on clot burden/ICH status?
Is there any evidence supporting the use of heparin boluses?
3 Answers available
What factors should be prioritized when deciding the timing of CIED extraction in patients with high surgical risk or multiple comorbidities?
1 Answer available
How would you manage hemodialysis for an ESKD patient who presents with a phosphorus of 1.6 mg/dl and potassium of 6.5 mEq/L without ECG changes?
2 Answers available
Are there situations where you would consider treating E faecalis or E faecium that grows from a respiratory culture?
1 Answer available
Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?
2 Answers available
What recommendations do you have regarding the use of dronabinol to prevent cannabis withdrawal in an inpatient medical or psychiatric setting?
2 Answers available
How long do you wait before arranging AVF placement in patients with AKI who remain dialysis dependent?
2 Answers available
When do you consider long-term anti-seizure medication for patients who have an acute symptomatic seizure in the setting of a cerebrovascular event?
1 Answer available
Would you consider an ICD for secondary prevention in an otherwise previously healthy adult found to have severe LV systolic dysfunction admitted s/p VF/VT arrest due to profound hypokalemia and hypomagnesemia, or defer implantation given resolution of arrhythmias after correcting electrolyte abnormalities?
If plan for ICD implantation, when would be the best timing to perform this? 
1 Answer available
How do you mitigate risk when performing bronchoscopy in hypoxic patients requiring high levels of supplemental oxygen?
Is there a threshold amount of oxygen above which you would avoid bronchoscopy?
2 Answers available
How do you decide between oral vs nasal route of entry for bronchoscopy with BAL with moderate sedation?
4 Answers available
In patients presenting to the hospital with atrial fibrillation of >/= 48 hours and are started on anticoagulation, provided they spontaneously convert with AV nodal blocking agents but then revert back into AF, would you need LAA imaging before a rhythm control strategy with AADs or cardioversion?
Does the “48-hr” criteria reset itself after the patient reverts back into atrial fibrillation? 
1 Answer available
How do you decide between opting for semi-elective outpatient versus inpatient TAVR for patients with severe critical AS?
1 Answer available
What would be your approach to managing severe ANCA-associated vasculitis in a patient who is also septic from a bacterial infection?
1 Answer available
Are there instances when you recommend initiation of dialysis in patients with advanced chronic kidney disease who are scheduled for a major surgery but do not currently have any indications for renal replacement therapy?
4 Answers available
What is your typical approach to the use of beta blockers in the setting of recent cocaine use amongst patients presenting with cocaine-related MI, arrhythmias, or new-onset heart failure?
If these patients were already prescribed non-selective beta blockers outpatient, do you recommend withholding these medications in the acute phase?&n...
2 Answers available
Should platelet transfusions be considered for anti-platelet agent reversal in patients with major bleeding?
2 Answers available
How do you manage MAT for opioid use disorder in lung transplant patients during the peri/postoperative period?
1 Answer available
Do you use standard dose or "meningitis dosing" of antibiotics when treating epidural abscesses, in the absence of CNS symptoms?
7 Answers available
How do you manage hemodialysis for an ESKD patient presenting with severe hyponatremia and a serum sodium more than 10 mEq/L below the lowest available dialysate sodium concentration?
2 Answers available
In cases of intermediate-risk pulmonary embolism, what factors influence your decision to pursue catheter-directed thrombolysis?
3 Answers available
Do you use dual anti-platelet therapy inpatients with low NIHSS who have had bilateral brainstem strokes?
1 Answer available
What is the preferred antibiotic treatment regimen for vancomycin-resistant Enterococcus faecium endocarditis assuming susceptibility to both daptomycin and linezolid?
1 Answer available
Following left main bifurcation stenting, do you routinely proceed with kissing balloon inflation of the side branch, either LCx or LAD?
7 Answers available
How frequently, and in which situations do you use quantitative EEG for the detection and/or monitoring of delayed cerebral ischemia after aneurysmal SAH?
4 Answers available
How to approach reversal of TNK in hemorrhagic conversion of ischemic stroke?
Considering the short half-life, at what point would it be deemed too late to administer any reversal agent, and to consider withholding it?
2 Answers available
How frequently do you check serum electrolytes for patients on CRRT?
1 Answer available
How do you manage headaches in stroke patients?
Is there a difference in headache management in ischemic stroke versus hemorrhagic stroke? How to best manage patients with underlying migraine who...
2 Answers available
How do you decide when to use andexanet (ANDEXXA) for intracranial hemorrhage associated with factor Xa inhibitors?
In light of ANNEXA-I RCT results: Connolly et al., PMID 38749032.
1 Answer available
Do all patients referred for acute symptoms of TIA or minor stroke require additional imaging with CT/MR angiography, in addition to admission/observation? 
Can some patients referred for TIA/stroke symptoms who have at the time of ER referral, a normal neurological exam be discharged with outpatient worku...
3 Answers available
How would you determine the safety of anticoagulation in patients with evidence of cerebral microhemorrhages who present with acute stroke secondary to cardioembolism?
4 Answers available
In addition to ampicillin, is there any benefit to the addition of either gentamicin or Bactrim when treating a patient with listeria meningitis?
3 Answers available
What additional workup would you recommend for a patient with a liver abscess caused by Fusobacterium and Aggregatibacter, who has had unrevealing endoscopies and no other abdominal masses on a CT scan?
1 Answer available
What factors influence your decision to start salt tablets, urea, or a vaptan first in the management of a patient diagnosed with SIADH?
3 Answers available
Do you continue antiplatelet/anticoagulant therapy in patients with hemodynamically stable diverticular bleeding to improve localization and treatment of source of bleeding?
3 Answers available
How do you manage concurrent non-life-threatening hemoptysis and acute pulmonary embolism?
Estimating blood loss from hemoptysis is not always reliable. The bleeding may be due to the PE itself. Is anticoagulation with any degree of hemoptys...
1 Answer available
When do you usually introduce conversations regarding tracheostomy placement in patients with refractory status epilepticus, or other conditions where one may anticipate delayed awakening?
1 Answer available
Do you routinely recommend diagnostic endoscopy for patients with persistent enterococcus bacteremia despite receiving adequate antimicrobial therapy and no clear nidus?
Rogers & Rice, PMID 38018162
2 Answers available
Are there factors that would prompt you to consider the use of methylene blue in refractory septic shock?
1 Answer available
Does your hospital or institution have an Antimicrobial Stewardship Program (ASP), which oversees ID physicians, and if so, does the ASP have the authority to refuse an antibiotic prescribed by an ID consultant?
ASPs are common place. The studies supporting ASPs oversaw doctors, not specifically trained in Infectious Diseases. However, several institutions hav...
3 Answers available
Is there a serum ammonium level for which you recommend initiation of dialysis in a patient with hepatic encephalopathy?
2 Answers available
Excluding CLL, in which patients would you screen for hypogammaglobulinemia?
Solid tumor patients, other hematologic malignancies, patients with autoimmune diseases on immunosuppressive therapy? Do you consider workup if they a...
1 Answer available
For patients with candida species osteomyelitis who have undergone extensive surgical debridement, do you routinely still recommend 6-12 months of antifungal therapy or opt for a shorter duration?
1 Answer available
Do you ever use amantadine or modafinil to aid in the rehabilitation of patients with ischemic strokes?
In patients who have decreased arousal after ischemic stroke, do you use amantadine or modafinil to aid with wakefulness and interaction with therapy ...
3 Answers available
What antibiotics would you use for empiric treatment of a brain abscess in patients allergic to penicillin, metronidazole, and vancomycin?
1 Answer available
Would you still consider adding clindamycin for streptococcal toxic shock syndrome in situations where the isolate is considered to be resistant?
1 Answer available
What is your calcium level threshold for initiating targeted calcium lowering therapies for patients with an acute kidney injury believed secondary to renal vasoconstriction and volume depletion?
1 Answer available
Do you routinely use two empiric antibiotics to cover for Pseudomonas aeruginosa in the management of CF exacerbations?
3 Answers available
What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?
Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...
1 Answer available
What is your protocol for transitioning to oral anticoagulation post-thrombolysis for pulmonary embolism?
High-risk PEs are typically treated with loading doses of anticoagulants or bridging with LMWH. Do you omit the bridging/loading period and go straigh...
1 Answer available
How would you manage a CVST secondary to a traumatic brain injury with the presence of intracranial hemorrhage?
When would you consider using anticoagulation and for how long?
4 Answers available
Do you refer all patients with new findings of CNS or epidural mets/tumor to ED for evaluation or are there some that can be managed completely outpatient?
E.g., patients with small CNS mets without vasogenic edema or symptoms. Epidural disease without epidural spinal cord compression or asymptomatic low-...
5 Answers available
When do you consider lumbar spinal fluid drainage after acute spinal cord injury?
1 Answer available
Would you consider treating hypercalcemia with CRRT and regional citrate anticoagulation for a dialysis dependent patient who does not respond to bisphosphonate therapy and low calcium dialysate bath?
2 Answers available
What are the next steps in the management of a patient admitted with an IPF exacerbation resistant to steroid therapy?
2 Answers available
When would you consider elective hospitalization for parenteral treatment for new daily persistent headache?
1 Answer available
Would you recommend desmopressin for a patient with ESKD receiving thrice weekly hemodialysis who is hospitalized for a persistent gastrointestinal bleed not amenable to usual interventional treatment strategies?
1 Answer available
What is your approach to duration of fidaxomicin in a patient receiving treatment for first C difficile infection while also receiving concurrent antibiotics for an infection? 
Do you extend the course of fidaxomicin past initial 10 days to at least 3-7 days after completion of antibiotics?
1 Answer available
What precautions should be taken when discharging a patient from the medical setting on new medication assisted therapy for alcohol use disorder?
This is based on the recent publication by Bernstein et al., PMID 38551564 which investigated the increased rate of initiation of MAUD in the hospital...
5 Answers available
What is your approach to management and surveillance in low grade traumatic blunt ICA injury?
1 Answer available
How do you approach inpatient DVT prophylaxis in patients already on low dose rivaroxaban 2.5 mg BID for PAD?
Do you increase rivaroxaban to 10 mg daily during the inpatient stay, or do you prefer to add LMWH or SC heparin?
1 Answer available
In massive transfusion protocol from suspected hemorrhage, is it worth obtaining a TEG to guide transfusion?
1 Answer available
In light of recent trials evaluating NPO before cath (CHOW NOW, SCOFF, etc.) are centers still restricting oral intake pre-procedure?
3 Answers available
Do you routinely obtain a CXR or CT after identifying an etiology for dyspnea on POCUS?
1 Answer available
What is your preferred dosing of IV ganciclovir for CMV disease in immunocompromised patients?
1 Answer available
What is your approach to using ketamine for agitation in the ED setting?
1 Answer available
How would you approach antithrombotic therapy in patients with acute ischemic infarcts and a non-occlusive intracranial thrombus?
Would you adjust your approach based on the infarct size, symptom severity, or stroke etiology?
3 Answers available
For outpatients undergoing a kidney biopsy, do you routinely recommend an overnight admission for continued hemoglobin monitoring?
8 Answers available
What would be your approach to percutaneous intervention for acute plaque rupture and cardiogenic shock for a patient with cirrhosis and severe thrombocytopenia?
2 Answers available
Would you consider PPM implantation for patients during their hospital stay following TAVR if they were to develop lengthening PR intervals and widening LBBB QRS duration exceeding 150ms afterwards?
Would your threshold to consider a device be lowered if their LVEF was also severely reduced? 
1 Answer available
Have you incorporated the use of linezolid in lieu of vancomycin plus clindamycin for empiric treatment of necrotizing fasciitis?
1 Answer available
Is there a serum phosphorus level you would consider too low to safely perform hemodialysis?
3 Answers available
What is your approach to determining the safety, appropriateness, and timing of SPECT or PET MPI in patients admitted with NSTEMI and who remain chest pain-free and hemodynamically stable? 
1 Answer available
Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?
3 Answers available
Do you add gentamicin when treating prosthetic valve endocarditis secondary to viridans group Streptococcus with a penicillin-intermediate isolate (MIC >0.125 - <0.5)?
3 Answers available
How do you calculate QTc intervals in patients being admitted for AAD drug loading who remain in atrial fibrillation or atrial flutter?
2 Answers available
What do you consider when selecting an antipsychotic medication for acute agitation?
Many institutions have been using droperidol in place of haloperidol due to drug shortages.
1 Answer available
What is your approach to managing patients who initially present with symptomatic intracranial large vessel occlusion but subsequently experience resolution of symptoms or become non-disabling before any intervention?
Would your management be different if the LVO was found on imaging without preceding associated symptoms?
4 Answers available
Do you recommend procalcitonin to help convince other providers to stop antibiotics in patients with pneumonia in whom a non-infectious diagnosis is strongly suspected?
2 Answers available
How would you approach treatment in a patient with refractory Coccidioidal meningitis who has previously been treated with IV amphotericin B?
1 Answer available
What medications are preferred and contraindicated for insomnia in patients with a recent stroke or traumatic brain injury?
1 Answer available
Are there instances when you do not recommend tunneled dialysis catheter exchange in patients on hemodialysis who are found to have bacteremia?
4 Answers available
Is there any role for IVIG or steroids in viral myositis complicated by severe rhabdomyolysis, diffuse compartment syndrome, DIC, and AKI?
1 Answer available
What are your management strategies for malignant pericardial effusion with a high risk of spontaneous hemorrhage, particularly in patients requiring anticoagulation for chronic atrial fibrillation?
1 Answer available
Do you ever favor cefazolin over ceftriaxone for bacteremia with susceptible E. coli?
1 Answer available
When do you discontinue contact precautions in patients known to be colonized with ESBL-producing Enterobacterales?
3 Answers available
How do you utilize Diamox in patients with cerebral venous sinus thrombosis and vision symptoms who do not undergo thrombectomy/recanalization?
3 Answers available
How do you approach anti-seizure medication management when it was started by another team for a seizure-naive patient before/after craniotomy for a tumor?
1 Answer available
Do you recommend any CRRT prescription changes for optimal clearance for patients with AKI who are on a reduced blood flow rate due to concurrent regional citrate anticoagulation?
2 Answers available
What is the best approach in management of device related thrombus seen immediately after watchman deployment?
Watchman device deployed with therapeutic ACT but required multiple recaptures. Patient went into afib during the procedure and after final deployment...
1 Answer available
For patients with newly diagnosed VTE on IV heparin planned for transition to DOAC, would you start at the loading or maintenance DOAC dose?
If they have been on IV heparin for 3 days, for example, would you subtract those days from the recommended loading dose time?
3 Answers available
Would you recommend hospitalization for surgery for a large papillary fibroelastoma or atrial myxoma discovered on an outpatient echocardiogram?
Would the context of prior stroke/TIA impact the decision to hospitalize or pursue expedited outpatient evaluation?
1 Answer available
How do you approach managing clozapine in patients who are critically ill?
1 Answer available
How do you approach treatment of vasospasm after AVM rupture?
1 Answer available
Should we recommend SGLT2i initiation at discharge to all patients hospitalized with acute myocardial infarction?
Butler et al., PMID 38587237
1 Answer available
When do you recommend plasmapheresis/plasma exchange for management of severe hypertriglyceridemia?
2 Answers available
What is your preferred agent and duration to treat an epidural abscess due to azole-resistant candida species?
1 Answer available
Do you add adjunctive gentamicin and/or rifampin for treatment of prosthetic valve Staphylococcus aureus endocarditis?
3 Answers available
What is your preferred intravenous fluid type for matching volume loss in a patient with persistent surgical drain output and pre-renal acute kidney injury?
1 Answer available
How long do you wait before starting a non-selective beta blocker in patients with newly reduced LVEF and recent cocaine use?
1 Answer available
What has been your stepwise approach to oxygenation, including when to consider the use of inhaled nitric oxide or epoprostenol, in refractory hypoxemia due to cardiogenic pulmonary edema in patients who are otherwise not ECMO candidates?
1 Answer available
How do you manage critically ill poor risk mixed germ cell tumor patients presenting de novo with extensive lung metastases and severe respiratory failure?
Data from Massard et al., PMID 20181575 used an abbreviated 3-day course of EP with completion of EP and bleomycin at day 15. Should this approac...
1 Answer available
Which patients with cirrhosis and portal hypertension are ideal candidates to undergo TIPS to reduce perioperative risk in anticipation of an elective surgery?
1 Answer available
What is the stepwise investigation of patients suspected of inflammatory myopathy?
Especially in an inpatient setting when EMG is not immediately available.
5 Answers available
For patients presenting with ACS and severe aortic stenosis with critical left main disease, would you consider BAV prior to PCI to the left main?
2 Answers available
What is your approach when cryptococcus serum or CSF antigen titers do not change despite treatment in HIV-positive patients with cryptococcal meningitis or invasive disease, but there is clinical improvement and cultures remain negative?
1 Answer available
Would you recommend administering IV amino acids prior to cardiac surgery with cardiopulmonary bypass, given recent trial findings of improved AKI rates but no significant difference in kidney-replacement therapy with IV amino acids?
Landoni et al., PMID 38865168
1 Answer available
How does premorbid dementia affect your decision to offer acute stroke intervention?
In light of the publication by Ganesh et al., PMID 39503052.
4 Answers available
In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?
3 Answers available
How do you decide between ceftolozane/tazobactam and ceftazidime/avibactam for empiric treatment of an infection due to difficult-to-treat Pseudomonas aeruginosa while awaiting additional susceptibilities?
2 Answers available
For patients with high-risk stress test features with ischemic EKG changes and mild to no symptoms, what would be your threshold to directly admit them for coronary angiography, or pursue outpatient elective coronary angiogram?
1 Answer available
Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?
Data on the role of steroids in HIV negative patients with PJP has been conflicting.
2 Answers available
What is your hemoglobin target for PRBC transfusion in cases of acute brain injury?
Have recent trials (TRAIN trial and HEMOTION trial) influenced your approach? 
1 Answer available
Have you considered priming CRRT machines with renal replacement solutions during the current crystalloid solution shortage?
2 Answers available
Does TpA or TNK cause acute post infusion severe headache with no intracranial bleed?
1 Answer available
What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?
For example, is captopril dialyzable? 
1 Answer available
Can defibrotide be given safely for VOD in patients with refractory thrombocytopenia to platelet transfusions?
1 Answer available
Do you recommend early oral nutrition when managing diabetic ketoacidosis?
Some data showed early enteral nutrition improves outcomes in DKA. Some thought that enteral nutrition could counteract the insulin gtt.
1 Answer available
Are there instances where you may transiently transition a perioperative ESKD on PD inpatient from peritoneal dialysis to hemodialysis if they are likely to receive a large volume of fluid?
Invited Professor Series Video: Volume Management and Access Troubleshooting in Peritoneal Dialysis - Claretha Lyas, MD
2 Answers available
What do you do for patients who have received accidental extra dosages of long-acting injectable antipsychotics?
3 Answers available
Do you recommend routine use of protamine for hemostasis at the end of a transfemoral TAVI?
1 Answer available
How would you manage a patient with CKD4 due to lupus nephritis of unknown class who develops AKI requiring hemodialysis and nephrotic range proteinuria and is found to have atrophic kidneys on imaging?
3 Answers available
Do shorter door-to-balloon (D2B) times impact outcomes in STEMI, if it's already less than 90 minutes, and to what degree (i.e., 30 vs 60 minutes would have a more significant impact)?
1 Answer available
Do you consider the use of tocilizumab in patients with COVID pneumonia who have had an improvement in supplemental O2 requirements but have significantly elevated inflammatory markers after day two of remdesivir and dexamethasone?
1 Answer available
Do you routinely perform a pre-extubation bronchoscopy for secretion clearance during the index hospitalization in patients following lung transplantation?
2 Answers available
Do you recommend CT perfusion in patients presenting with symptoms of acute stroke before 6 hours?
7 Answers available
What is the utility of granulocyte infusions in patients with neutropenia and severe infection?
1 Answer available
How do you decide between administering or deferring upstream P2Y12 inhibitor treatment until patient is in the lab for NSTEMI or STEMI cases with unknown coronary anatomy?
2 Answers available
What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?
1 Answer available
What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?
1 Answer available
Do you avoid performing urine microscopy in patients with AKI who have COVID-19 given concern for potential aerosolization?
2 Answers available
Are there clinical scenarios in which you would start empiric treatment for pulmonary TB without microbiologic confirmation?
2 Answers available
Is there a role for using continuous glucose monitors for perioperative glucose monitoring in patients with diabetes?
1 Answer available
Do you consider tracheostomy for the management of continued hypercapnea despite compliance with PAP in patients with OHS and OSA?
2 Answers available
Are there any instances when you would not perform 3 consecutive daily dialysis sessions when initiating a patient on hemodialysis?
2 Answers available
When would you initiate exchange transfusion in babesiosis and significant hemolysis?
Is parasitemia >10% and severe hemolysis with Hb less than 7 enough to initiate this?
1 Answer available
How often do you recommend basic metabolic panel checks in a hospitalized ESKD patient on thrice weekly hemodialysis and for whom hyperkalemia is not of major concern?
2 Answers available
What is the upper limit of blood glucose target in hyperglycemic critically ill patients?
The new SCCM guidelines suggest an upper limit of 200 compared to the conventional 180.
1 Answer available
How do you identify which patients are at highest risk for decompensation and most likely to benefit from NIV for pre-oxygenation prior to intubation?
2 Answers available
Does the experience level of the intubation operator affect outcomes related to pre-oxygenation with NIV versus an oxygen mask?
2 Answers available
Does the use of NIV for pre-oxygenation delay the time to intubation?
2 Answers available
What factors do you consider for patients on an individual basis when establishing a post-cardiac arrest MAP goal after ROSC is achieved, considering some may benefit from higher MAP goals for optimal cerebral perfusion?
1 Answer available
What would be the preferred treatment option for PMR if patient develops gastric perforation soon after initiation of steroids?
1 Answer available
Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?
1 Answer available
Do you take into consideration a patient's serum albumin level in your decision to use ertapenem?
2 Answers available
How do you decide on the timing and number of blood cultures for suspected endocarditis given the differences in recommendations between the ESC guidelines and the Duke Criteria?
The ESC guidelines recommend obtaining at least three sets of blood cultures at 30-minute intervals before starting antibiotic therapy, each with 10 m...
3 Answers available
How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?
Kunadian, et al., PMID 39225274
1 Answer available
What is your approach to weaning dialysis in a patient with AKI on CKD and CHF who now has resolved AKI but a history of recurrent episodes of decompensated heart failure?
1 Answer available
What is your approach to evaluating a patient with a suspected myocardial contusion?
1 Answer available
What blood pressure targets do you enforce in the first 24-48 hours in a patient who develops an intracranial hemorrhage after mechanical thrombectomy?
Blood pressure targets for ischemic stroke and intracerebral hemorrhage are described in several guidelines. However, in patients with acute stroke wh...
2 Answers available
What is your daily correction goal for those patients being treated for hyponatremia?
1 Answer available
What factors influence your decision between guidewire exchange versus removal and replacement through a new tunnel tract for patients with tunneled hemodialysis catheter mechanical failure?
Lazarus, et al., PMID: 38913437
1 Answer available
What are the logistical challenges and time constraints of implementing NIV for pre-oxygenation in emergency settings compared to oxygen masks?
1 Answer available
Would bag-mask ventilation with a PEEP valve be a reasonable alternative to NIV for pre-oxygenation prior to intubation in settings where NIV is not easily accessible?
1 Answer available
Is there a subset of patients in whom pre-oxygenation with NRB or BVM could be safely pursued?
1 Answer available
In which clinical scenarios do you use prolonged intermittent renal replacement therapy (PIRRT)?
2 Answers available
Do you recommend plasmapheresis for treatment of patients with osmotic demyelination?
1 Answer available
Do you recommend prophylactic post-operative use of an intravenous calcium infusion for patients with ESKD who undergo subtotal parathyroidectomy for secondary hyperparathyroidism?
1 Answer available
Do you administer calcium to patients with K > 6.5 without EKG changes?
3 Answers available
What is your approach to interpreting urine studies in patients hospitalized for hyponatremia who have recently received intravenous fluids containing sodium chloride?
1 Answer available
When attempting PEEP titration, how long do you wait after decrements or increments to assess for a change in driving pressure?
2 Answers available
Do you routinely perform echocardiography in patients with Staphylococcus aureus bacteremia deemed low risk for metastatic infection, or do you selectively omit it based on specific clinical criteria?
Hendriks, et al., PMID 38576380
2 Answers available
Under what circumstances do you consider valacyclovir for the management of VZV disease of the CNS?
2 Answers available
What are first-line choices for vasopressors/inotropes to use in hypotensive patients with Eisenmenger Syndrome?
1 Answer available
How do you medically manage acute basilar artery occlusion in patients with low NIHSS who are not candidates for EVT but at risk for deterioration?
2 Answers available
Do you recommend fluid restriction in addition to other management strategies for patients with hyponatremia due to SIADH?
5 Answers available
What is your approach to using beta-blockers in patients with acute myocardial infarction with preserved LV ejection fraction who undergo early coronary angiography in light of the REDUCE-AMI trial findings?
REDUCE-AMI trial
2 Answers available
How would you approach management of a patient with a medium-to-large vessel vasculitis who developed perforation of the stomach and colon on steroids and cyclophosphamide?
Vasculitis involving aorta, subclavian, common carotid, SMA, IMA, renal artery, and celiac artery.
1 Answer available
How do you approach determining appropriateness for extubation in a patient with acute respiratory failure in the setting of known chronic neuromuscular disease?
1 Answer available
Do you use absolute random cortisol levels or delta cortisol levels after ACTH stimulation to diagnose adrenal insufficiency in the critically ill?
2 Answers available
Do you preferentially avoid use of piperacillin-tazobactam for empiric anti-pseudomonal coverage in hospitalized patients due to risk of nephrotoxicity?
ACORN Randomized Clinical Trial 
1 Answer available
Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?
2 Answers available
Do you routinely check cefepime levels in patient's with suspected cefepime-induced neurotoxicity?
1 Answer available
Do you ever start a ketogenic diet in patients who present with status epilepticus admitted to the ICU?
1 Answer available
How frequently do you recommend flushing a peritoneal dialysis catheter for patients with ESKD who are hospitalized and are not currently undergoing peritoneal dialysis?
6 Answers available
Would you recommend normal saline for pre- and post-LHC hydration in patients with CKD stage III to IV with reduced LV systolic function, and if so, what is a reasonable amount of volume?
2 Answers available
When do you recommend hyperacute MRI for patients with wake-up stroke?
2 Answers available
What is your intraprocedural approach to reducing time to reperfusion in STEMI cases: opting for culprit lesion PCI first then complete angiography, or complete angiography followed by culprit lesion PCI?
Levi et al., PMID 38551563
2 Answers available
In which cases would you consider early transition to DOAC (within 72 hours) for hospitalized patients with intermediate or high risk PE?
Assume thrombolytics are not indicated. Do you favor early DOAC transition after 24-48 hours of heparin gtt or do you favor LMWH for 10-14 days follow...
2 Answers available
What is a reasonable inpatient imaging modality alternative to evaluate for infective endocarditis in a morbidly obese patient with poor acoustic windows on TTE and persistent bacteremia if TEE is not feasible or contraindicated?
4 Answers available
When would you consider AV nodal ablation in CRT-non-responders with persistent atrial fibrillation?
1 Answer available
Do you use terlipressin for patients with hepatorenal syndrome who also have elevated blood pressures?
1 Answer available
How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?
1 Answer available
When would you consider using Ibutilide for rapid pharmacologic cardioversion of atrial fibrillation?
1 Answer available
What is your approach to management of CIED in a patient with community-acquired Staph aureus bacteremia who clears blood cultures quickly with negative follow up blood cultures within 72 hours of antimicrobial therapy and negative TEE?
Would you still routinely ask for CIED removal, or would you pursue PET/CT for further evaluation and consider keeping CIED if PET/CT negative?
2 Answers available
When pursuing complex PCI of the RCA (especially when lesion preparation is required), when do you consider placing a transvenous pacemaker in anticipation of conduction abnormalities?
5 Answers available
How would you manage anticoagulation in a patient with acute MI or PE with prolonged aPTT due to congenital factor XII deficiency?
1 Answer available
What steps do you take in managing catatonia with limited response to lorazepam?
1 Answer available
In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD? How frequently do you monitor osmolarity?
1 Answer available
Do you typically load DAPT in patients with ICAD?
2 Answers available
Do you hospitalize patients with newly diagnosed lupus nephritis and nephrotic syndrome if you are able to provide pulse steroids outpatient and follow them closely?
 When do you decide to hospitalize?
1 Answer available
What is the preferred four-drug regimen for initial treatment of pan-susceptible tuberculous meningitis, given the need to achieve optimal CNS penetration?
1 Answer available
In drawing blood cultures from a central line to evaluate for CLABSI, do you advise drawing separate blood cultures from each port in case of dual or triple lumen line?
If yes, what is the rationale for doing that? 
3 Answers available
In clinical practice, are you using single-dose liposomal amphotericin B for treatment of cryptococcal meningitis for patients living with HIV?
1 Answer available
Do you continue to prone patients with severe ARDS after initiation of VV-ECMO?
1 Answer available
Can intra-abdominal pressure serve as a surrogate for pleural pressure to titrate PEEP in obese patients or those with intra-abdominal hypertension?
1 Answer available
Is the adage “If GCS <8, intubate” still relevant for non-TBI patients?
Do the findings of the NICO trial influence your stance?
2 Answers available
How do you manage patients with embolic stroke of an undetermined source and a papillary fibroelastoma found on an echocardiogram?
Are there specific mass features that would influence your treatment decision?
1 Answer available
Will you begin considering TNK for ischemic stroke patients with a large vessel occlusion presenting outside the 4.5-hour window?
In light of TIMELESS and TRACE-III trials.
2 Answers available
Do you use combination antibiotic therapy for treatment of bacterial endocarditis due to gram-negative bacilli?
1 Answer available
What is your preferred fill volume, dialysis solution, and dwell time for patients with suspected peritoneal dialysis associated peritonitis who arrive to the hospital with a dry abdomen?
2 Answers available
When do you consider ketamine to treat nonconvulsive status epilepticus?
1 Answer available
How do you decide on the treatment target of burst suppression pattern vs seizure cessation for patients with status epilepticus?
1 Answer available
Do you favor aggressive airway clearance regimens or bronchoscopy for clearing occluding mucous plugs in patients who are not in respiratory distress?
1 Answer available
Should one perform a subsequent screening CTA or MRA head for mycotic aneurysm after cardio-embolic strokes in a setting of endocarditis with initial unremarkable CTA or MRA head/neck?
2 Answers available
Do you perform a kidney ultrasound in patients following a kidney biopsy to evaluate for post-procedural complications?
2 Answers available
What is your approach to antimicrobial prophylaxis in adult patients undergoing treatment for HLH?
1 Answer available
Would you consider reducing the dialysate sodium concentration to 135 meq/L as a strategy to decrease interdialytic weight gain in a hypervolemic ESKD patient?
Miskulin, et al., PMID 38349776
1 Answer available
Do you use combination therapy for persistent MSSA bacteremia?
If yes, which combination(s)?
1 Answer available
Do you prefer a loading dose of 300mg or 600mg plavix for patients presenting with NSTEMI or unstable angina about to undergo LHC?
Does your preferred dose change if this were in a non-ACS setting with elective outpatient PCI? 
2 Answers available
Do you use a phosphate binder to manage inpatient hyperphosphatemia in patients with AKI who have no history of CKD?
5 Answers available
Is there still a role for direct laryngoscopy in the intubation of patients in the ICU?
Multiple recent trials have shown higher first pass success rate with VL over DL.
1 Answer available
Do you routinely ask for removal of a indwelling central line (PICC or tunneled catheter) in a patient with pseudomonal bacteremia from known source with otherwise appropriate clinical improvement on anti-pseudomonal antibiotic therapy?
1 Answer available
Would you recommend a TIPS procedure in the management of hepatorenal syndrome for a patient with no history of hepatic encephalopathy?
1 Answer available
How have the findings from DanGer Shock RCT changed your perspective on which patients presenting with acute MI complicated by cardiogenic shock would benefit from Impella for additional hemodynamic support?
2 Answers available
Do you administer prophylactic antibiotics to prevent VAP following intubation in patients with acute brain injury?
Do the findings of the PROPHY-VAP trial influence your approach?
2 Answers available
What would be your advice to providers who are wary of QTc prolongation after starting an amiodarone load and wish to discontinue it?
Is there a percent change in QTc in which you would consider stopping amiodarone, especially in patients who have baseline wide QRS complexes? 
1 Answer available
How long would you treat an upper urinary tract infection in a patient with acute obstructive pyelonephritis due to a kidney stone status-post urinary stenting without yet removal of the stone?
4 Answers available
Do you recommend routine ophthalmologic exam for all patients with hypervirulent Klebsiella pneumoniae bacteremia?
1 Answer available
When do you consider the use of steroids in the management of acute exacerbations in patients with cystic fibrosis?
3 Answers available
Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?
3 Answers available
Do you consider use of convalescent plasma early in disease course in COVID-19 induced ARDS in mechanically ventilated patients?
Do the results of the recent study (Misset et al., PMID 37889107) showing reduction in 28-day mortality in patients with high neutralizing antibody ti...
1 Answer available
What would be your threshold to recommend TEE guided DCCV in a patient who has remained in atrial fibrillation in the post-operative period following CABG, who has achieved adequate amiodarone loading dose?
1 Answer available
Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?
2 Answers available
Is there a role of maximizing GDMT medications for patients with durable VADs?
1 Answer available
What is your approach to withdrawal of ventilatory support at the end of life?
Do you favor gradual reduction in oxygen and pressure support with intermittent medication as needed or immediate extubation with peri-extubation medi...
1 Answer available
What is the expected timeframe one would expect to see paroxysmal sympathetic hyperactivity/sympathetic storming persist post-traumatic brain injury?
For example, in the setting of TBI, how do you guide the duration of the medical treatment?
2 Answers available
Have you used oral vancomycin as prophylaxis for C difficile infection in patients admitted for allogeneic hematopoietic cell transplant?
2 Answers available
How do you decide the right time for MitraClip intervention in patients with symptomatic heart failure and severe mitral regurgitation who are on maximally tolerated GDMT?
1 Answer available
What is your approach to anticoagulation in a patient with AKI and cirrhosis who has frequent filter clotting on CRRT?
2 Answers available
Do you start patients on a B complex multivitamin if they are on CRRT and have not previous been on renal replacement therapy?
1 Answer available
Would you consider deferring chest tube placement in a clinically stable patient with a small empyema without signs of systemic infection?
2 Answers available
Is a larger bore percutaneous chest tube sufficient to adequately drain a hemothorax, or is a surgical chest tube required?
1 Answer available
How do you choose between eculizumab and ravulizumab for patients with acute kidney injury from complement mediated thrombotic microangiopathy?
1 Answer available
Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?
2 Answers available
Is there a good rationale for using vasopressors/induced hypertension in a patient with fluctuating neurologic deficits from symptomatic intracranial stenosis?
3 Answers available
What is your approach to safely performing hemodialysis in a patient with a fistula who is hospitalized for altered mental status and unable to remain still?
1 Answer available
How long would you treat a patient with recent history of TAVR presenting with E faecalis bacteremia with unclear source with TEE showing thickened valves but no obvious vegetation?
2 Answers available
What is your approach to the management of asymptomatic intracranial atherosclerosis discovered during the workup of an acute stroke?
Does it influence your choice of antithrombotic therapy? Do you perform serial follow-up imaging?
3 Answers available
What is your approach to the evaluation and management of a suspected intrapulmonary hematoma?
1 Answer available
What agents do you utilize for mucociliary clearance during the index hospitalization of patients post lung transplant?
1 Answer available
When do you consider nerve blocks for headache management in patients admitted to the neuro-intensive care unit with subarachnoid hemorrhage?
1 Answer available
Do you use intrapleural tPA/dornase in loculated effusions that are not due to infection?
1 Answer available
In which patients do you recommend craniectomy-watch after acute stroke?
2 Answers available
How do you assess the use of Heimlich valves for patients who present with persistent air leaks?
1 Answer available
What is your strategy for treating persistent headaches in the aftermath of subarachnoid hemorrhage?
Does your strategy change depending on whether or not it is a secured or unsecured aneurysmal SAH?
4 Answers available
Would you recommend TNK or DAPT in patients with stroke-like symptoms and NIHSS less than 5 presenting within 4.5 hours?
4 Answers available
How long should surgery be delayed in a patient with localized, resectable pancreatic cancer who developed acute pancreatitis following EUS guided biopsy?
And if delayed, should chemotherapy be started?
2 Answers available
Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?
Seethapathy et al., NEJM
5 Answers available
How do you treat a patient with a gram-negative infection with resistance to imipenem but sensitivity to meropenem and negative for Carbapenem resistant organism by xpert Carba-R-assay?
1 Answer available
Why are gout flares common in hospitalized patients undergoing diuresis but not commonly observed in cancer patients with hyperuricemia resulting from tumor lysis syndrome?
2 Answers available
Which factors would prompt empirical lead extraction in bacteremic patients without TEE evidence of lead vegetation?
1 Answer available
Have you incorporated the use of steroids for patients with severe community-acquired pneumonia?
In light of published data from the CAPE COD trial...
1 Answer available
What are your criteria for deciding if a patient who had VF arrest in the setting of subacute myocarditis requires ICD or long term WCD?
1 Answer available
Is there a role for chronic suppressive oral or inhaled therapy for recurrent Burkholderia cepacia pneumonia causing frequent hospitalizations in a patient with severe bronchiectasis with or without underlying cystic fibrosis?
3 Answers available
How do you approach the decision to use terlipressin in a patient with hepatorenal syndrome type 1, AKI, and a history of heart failure given its potential cardiovascular effects?
1 Answer available
Would you administer IV thrombolysis in a patient presenting with disabling stroke symptoms while on anti-amyloid therapy?
4 Answers available
Are contact precautions effective at preventing MRSA transmission in healthcare settings?
2 Answers available
For pregnant patients in their first trimester presenting with acute MI with plan for emergent angiogram, who then subsequently have resolution of chest pain and EKG changes following initiation of heparin gtt, DAPT, would you still consider proceeding with LHC or treat medically with presumptive diagnosis of SCAD?
1 Answer available
Do you use acetazolamide to aid diuresis in patients with acute on chronic respiratory acidosis with significantly elevated serum bicarbonate levels?
3 Answers available
In what clinical scenarios do you utilize post-cardiac arrest targeted temperature management (TTM)?
In the span between the HACA trial and the Targeted Temperature Management in Out-of-Hospital Cardiac Arrest study (Dankiewicz et al., PMID 34133859),...
1 Answer available
Do you recommend giving IV albumin with furosemide to augment diuresis in a patient with hypoalbuminemia and volume overload?
1 Answer available
What are your management strategies for acute kidney injury attributed to pembrolizumab in patients with a kidney biopsy showing predominately acute tubular injury?
2 Answers available
Do you increase the frequency of hemodialysis for patients with calciphylaxis?
3 Answers available
What considerations do you take when managing a patient with end stage kidney disease on peritoneal dialysis who is planning on undergoing PEG tube placement?
1 Answer available
Would you avoid the use of keppra in patients with TBI due to concerns for worsening agitation?
2 Answers available
What protective post-op measures do you recommend for a patient with scleroderma and a history of ILD, PH, Raynaud’s and digital ischemia undergoing cardiothoracic surgery?
1 Answer available
In patients being evaluated for brain death, which abnormal movements are definitively known to still be consistent with brain death and which are possibly consistent with brain death but lack definitive evidence?
What are the sources for this and are they reliable by today’s standards? Numerous case series report various abnormal movements but how reliabl...
1 Answer available
For patients on CRRT with worsening hyperkalemia despite high replacement fluid rate using a 0 mEq/L potassium bath, do recommend using an additional CRRT machine with separate dialysis access for improved clearance?
3 Answers available
What is your approach to monitoring for recovery in a patient with non-oliguric AKI requiring dialysis?
4 Answers available
Are CGRP antagonists effective at aborting intractable headaches in hospitalized patients when traditional “migraine cocktails” have failed?
2 Answers available
Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?
2 Answers available
What is your daily correction goal for those patients being treated for hypernatremia?
2 Answers available
Between mean arterial pressure (MAP) and blood pressure (BP), which do you use when prescribing hemodialysis to instruct a hold on additional ultrafiltration should the value become too low?
1 Answer available
Do you obtain an echocardiogram as a part of risk stratification in all patients hospitalized with an acute pulmonary embolism?
2 Answers available
What is your approach to monitoring the neurologic status of a patient with a traumatic brain injury requiring burst suppression for status epilepticus?
E.g., a patient has an intracranial hemorrhage after TBI with convulsive status epilepticus.
1 Answer available
Do you intensify the dialysis prescription for patients with end stage kidney disease who develop uremic pericarditis despite regular dialysis sessions?
3 Answers available
How do you manage patients with status dystonicus?
1 Answer available
When do you pursue interventional treatments in a lung transplant patient with anastomotic dehiscence complicated by a bronchopleural fistula?
1 Answer available
What is your approach to starting antiretroviral therapy in a patient living with HIV who is diagnosed with cryptococcal meningitis?
1 Answer available
Would you consider DHE for patients with status migrainous with elevated blood pressure at the time of presentation?
1 Answer available
What is your approach to the management of persistent hydropneumothorax due to a non expandable lung?
1 Answer available
What patient factors, if any, would lead you to extubate a patient at high risk of extubation failure to AVAPS rather than BIPAP?
1 Answer available
What factors do you consider while selecting high risk patients for prophylactic NIV after planned extubation?
1 Answer available
Is there benefit to performing CVVH instead of intermittent hemodialysis for a patient with AKI secondary to rhabdomyolysis who requires renal replacement therapy?
1 Answer available
Is there a role for routine EEG in the diagnostic evaluation of critically ill comatose patients or should these patients always receive long-term continuous video EEG monitoring?
How does the 2HELPS2B scoring tool play a role in your decision-making?
1 Answer available
How do you approach patients with recurrent TGA in the emergency room?
1 Answer available
What is your preferred mechanism for venting the left ventricle in patients on VA-ECMO?
2 Answers available
What is a reasonable hemoglobin goal for patients with chronic anemia presenting with acute MI?
1 Answer available
What would be your second pressor of choice if patients with LVOT obstruction remain persistently hypotensive on phenylephrine?
1 Answer available
Are SCDs contraindicated in patients with acute DVTs?
Is it different than early mobility that we always encourage?
3 Answers available
Do you treat patients with HIV-AIDS and positive cryptococcal antigenemia but negative CSF cryptococcal antigen with standard meningitis treatment given the potential for the postzone effect?
1 Answer available
How often do you check urine osmolality and urine electrolytes when treating hospitalized patients with hyponatremia?
2 Answers available
Would you give TNK or IVT to a patient with proximal occlusion and an NIHSS of 0-3 (non-disabling)?
How about a distal occlusion? The patient was initially symptomatic but symptoms improved or mostly resolved.
5 Answers available
When would you consider using hypertonic saline for patients with refractory acute decompensated heart failure and diuretic resistance?
1 Answer available
What would be your threshold to offer coronary angiography for patients presenting with atypical chest pain features and Wellens syndrome on EKG without a troponin elevation or dynamic EKG changes?
1 Answer available
How many times one can use IVIG in GBS?
Plasmapheresis first or IVIG first in GBS? What other treatment options are there for severe disabling GBS?
1 Answer available
Do you perform PEEP titration while patients are proned?
1 Answer available
Do you add fludrocortisone to hydrocortisone when starting stress dose steroids in a patient with septic shock?
Though there is data to support using both hydrocortisone and fludrocortisone, it seems to be used rarely in clinical practice. A review publishe...
1 Answer available
Should thyroid hormone replacement be initiated in patients with very prolonged critical illness with associated low thyroid hormone levels?
1 Answer available
In what situations would you consider ESAs in hospitalized patients with severe anemia for indications other than CKD or myelosuppressive chemotherapy (e.g., ACD, hemorrhage)?
Practice is variable in the community, with some hematologists frequently prescribing ESAs for severe anemia that is mostly inflammatory. Do the risks...
1 Answer available
Does your approach to extubating obese patients differ from your approach in non-obese patients?
1 Answer available
How do you prescribe ketamine for treatment of refractory status epilepticus, and what is its efficacy?
1 Answer available
Do you routinely use vasopressin in the management of RV failure leading to shock state in the absence of an obvious treatable cause such as infarction or PE?
2 Answers available
In patients presenting with ACS and multivessel disease, when do you favor immediate versus delayed complete revascularization?
If delayed complete revascularization is favored, would you consider staged PCI during that same admission or PCI outpatient? 
3 Answers available
For bone metastases requiring surgical stabilization, what time interval from the date of surgery do you use for post-op radiation?
What is the maximum time that can be used (given the complexities with patient being in the hospital or needing rehab)?
2 Answers available
Is there a role for inpatient EMG/NCS in patients who present with rhabdomyolysis with unclear etiology?
1 Answer available
What is your protocol to starting/stopping glucocorticoid replacement in Cushing disease patients after their transsphenoidal resection surgery?
1 Answer available
In patients with intrinsic acute kidney injury of unknown etiology and with pending kidney biopsy results, are there instances when you would recommend a trial of glucocorticoids?
1 Answer available
How long post operatively do you wait before transitioning from parenteral anticoagulation to oral anticoagulants after pulmonary thromboendarterectomy for CTEPH?
2 Answers available
How long would you wait for outflow to improve before consulting surgery in a peritoneal dialysis patient with an outflow obstruction who is prescribed laxatives for catheter migration?
Invited Professor Series Video: Volume Management and Access Troubleshooting in Peritoneal Dialysis - Claretha Lyas, MD
1 Answer available
How do you acutely manage a free-floating thrombus in a major artery in a patient with a stroke as a result of it?
4 Answers available
What is your loading dose goal and typical loading regimen for PO amiodarone in patients with atrial fibrillation?
Do you include the amount of IV amiodarone already administered as part of the loading dose? 
4 Answers available
Is there a particular PVC/NSVT burden on inpatient telemetry in which you would consider discharging a patient with a LifeVest post-STEMI with newly reduced LVEF <35% while optimizing GDMT?
1 Answer available
Do you treat Stenotrophomonas maltophilia bacteremia with combination therapy and if so, what is your preferred combination of antibacterials?
1 Answer available
For how long do you treat uncomplicated CRE bacteremia in an immunocompetent patient?
1 Answer available
What is your preferred strategy for controlling bleeding after transbronchial or endobronchial biopsies?
1 Answer available
What is your approach to counseling an octogenarian on the risks and benefits of LHC in the context of NSTEMI complicated by new-onset heart failure and AKI on CKD? 
If LHC is deferred, would you consider loading with plavix and treating for ACS for 48 hours (assuming acceptable bleeding risk) and optimizing GDMT p...
1 Answer available
How do you work up incidentally found papilledema in the emergency room?
2 Answers available
Would you attempt a brain MRI in patients who present to the ER with subacute presentation of obstructive hydrocephalus?
Given the risk of elevated ICP, would you attempt a brain MRI to further characterize the lesion? Or would CT imaging suffice prior to intervention?
1 Answer available
How do you manage postoperative head and neck cancer patients who have difficulty completing simulation due to copious secretions?
Aside from suctioning, what are other measures could be helpful?
4 Answers available
What burden of PVCs/NSVT in an inpatient post-MI cardiomyopathy patient would prompt an EP study-guided ICD implantation prior to discharge?
1 Answer available
Would you consider stepping down from an echinocandin to azole therapy prior to the end of an initial six-week course for fluconazole-susceptible Candida albicans endocarditis in the absence of valve surgery?
1 Answer available
What are some considerations to make when managing a patient on peritoneal dialysis who develops acute pancreatitis?
1 Answer available
How do you differentiate active vasculitis from pregnancy complications such as pre-eclampsia and HELLP in a patient with AAV?
3 Answers available
Which patients presenting with spontaneous ICH should be considered for a diagnostic cerebral angiogram/DSA?
1 Answer available
What is your approach to achieving hypernatremia in a patient on CRRT for whom increasing the rate of a post-filter 3% sodium chloride infusion is insufficient?
2 Answers available
When would you consider using acetazolamide to augment diuresis in patients with ADHF?
1 Answer available
Should bare metal stents be favored over drug eluting stents for pregnant patients presenting with acute coronary syndrome?
1 Answer available
In what clinical context would you consider offering first time catheter ablation for symptomatic atrial fibrillation in patients with advanced heart failure, as opposed to a trial of antiarrhythmics and/or cardioversion?
2 Answers available
Do you recommend checking urine sodium 2 hours after loop diuretic administration to determine the need for dose adjustment in a patient with acute decompensated heart failure?
1 Answer available
What are best practices in management of severe acute infusion reaction from infliximab?
Patient became acutely flushed, developed severe and prolonged hypotension with brief loss of consciousness, dizziness, nausea, dry heaves and headach...
1 Answer available
How often and when do you consider trending NT-proBNP levels for patients with HFrEF admitted for acute decompensated heart failure? 
1 Answer available
Would you start an amiodarone load for new onset atrial fibrillation with RVR intermittently in normal sinus rhythm to further suppress AF recurrence in the acute setting?
2 Answers available
Is there a platelet count threshold when you would avoid performing a kidney biopsy in patients with thrombocytopenia?
1 Answer available
When do you consider the use of corticosteroids in patients diagnosed with EVALI?
1 Answer available
What is your approach to volume resuscitation in patients with obvious septic shock but also with a component of suspected cardiogenic shock?
4 Answers available
Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?
2 Answers available
How do you approach the management of EBV Meningoencephalitis (CSF pleocytosis and CSF PCR positive for EBV)?
3 Answers available
How do you approach the management of GVHD prophylaxis in the setting of severe infection?
1 Answer available
Can subclinical hypothyroidism cause myxedema coma?
Elderly male with primary hypothyroidism, HTN, and progressive worsening cognition over several months. PCP has been increasing LT4 dose as outpatient...
2 Answers available
Do you use mannitol when initiating patients on intermittent hemodialysis?
1 Answer available
How would you approach a patient with GCA who develops necrotizing fasciitis and then flares because they are off of tocilizumab?
How would you treat?  Would you view tocilizumab as an option in the future? 
1 Answer available
Are there instances when you use erythropoietin stimulating agents in patients with acute kidney injury requiring dialysis?
2 Answers available
When should you use caplacizumab in the treatment of acute TTP patients?
1 Answer available
Do you attempt more aggressive PEEP titration to improve the P/F ratio prior to proceeding with proning in patients with ARDS and P/F <150?
1 Answer available
Should all pregnant patients with newly reduced LVEF <45% be referred as soon as possible to advanced heart failure given high risk for maternal morbidity/mortality in setting of suspected peripartum cardiomyopathy?
If PPCM is suspected, what are your targeted hemodynamic goals during the delivery phase? 
1 Answer available
Would you perform dialysis on a patient with altered mental status in the setting of an elevated blood urea nitrogen level attributed to a tube feeding diet?
1 Answer available
Do you hold CRRT for a period of time before performing a diuretic challenge in a patient with whom you are assessing for the ability to wean off of continuous dialysis?
2 Answers available
Would you consider adding an SGLT2 inhibitor to augment diuresis in patients with worsening renal function presenting with acute decompensated heart failure and AKI on CKD?
1 Answer available
Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?
2 Answers available
What adjustments do you make to a hemodialysis prescription for a patient with a recent stroke?
3 Answers available
Do you recommend using dextrose based solutions to induce osmotic diuresis for euvolemic patients with acute kidney injury in the setting of a hemolytic condition?
1 Answer available
Do you think repeated routine EEG is sufficient for cardiac arrest patients or should we be always using continuous EEG?
Many recent studies cast doubt on continuous vs repeated routine EEG.
1 Answer available
What is the appropriate cardiac work-up and management for an otherwise healthy individual who has experienced immersion pulmonary edema while scuba diving?
For the first time in my 27-year career, I was asked to consult on a patient in his early 40s with immersion pulmonary edema from scuba diving. &...
2 Answers available
How do you approach mitral valve endocarditis associated with a large vegetation size and severe mitral regurgitation, but without any heart failure, hemodynamic instability or valve destruction?
While the current guidelines favor early surgery (within 48 hrs of diagnosis) for this population based on the results of the EASE trial (link attache...
3 Answers available
When would you consider percutaneous mechanical aspiration of vegetation in right-sided endocarditis?
1 Answer available
What strategies do you employ to prevent post-intubation hypotension in a profoundly hypoxic patient given a paralytic for intubation?
1 Answer available
What strategies do you employ to minimize the risk of cardiovascular collapse when intubating a patient with severe pulmonary hypertension?
Do you favor awake intubation in these cases?
2 Answers available
Do you recommend transfer to an institution with a PE response team for a patient with an intermediate risk PE?
1 Answer available
Do you routinely screen for sleep apnea in patients with acute ischemic stroke?
3 Answers available
What are the preferred inotropes/vasopressors agents for cardiogenic shock in situations with and without LVOT obstruction?
Is there literature to support superiority of levophed over dobutamine, or vice versa? 
1 Answer available
For patients with acute ischemic stroke and BP >185/110, at what point do you consider persistently elevated BP too refractory to safely give thrombolysis?
Current guidelines (AHA, ESO, etc.) are not clear. In addition, if a patient arrives with BP>240 how do you balance the risk of hypoperfusion with ...
4 Answers available
What is the recommended approach for extracranial bleeding after tPA?
Fibrinogen level >200.
2 Answers available
For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention?
For patients with ischemic stroke status-post decompressive hemi-craniectomy, when should they start aspirin for secondary stroke prevention? POD 5? P...
2 Answers available
What is your preferred PO afterload-reducing agent immediately after being weaned off inotropic support in cardiogenic shock?
1 Answer available
What is your approach towards management of symptomatic broncholithiasis?
What factors do you consider while deciding between bronchoscopic vs surgical management?
1 Answer available
Do you use continuous or intermittent bronchodilator therapy in severe airway obstruction?
1 Answer available
Would you place an IVC filter in a patient with an acute intermediate risk PE and a proximal DVT who is on anticoagulation?
1 Answer available
What is your approach to inpatient immunosuppression for a kidney transplant patient on home tacrolimus, prednisone, and mycophenolic acid who cannot tolerate anything by mouth?
2 Answers available
For patients on immune checkpoint inhibitors presenting with chest pain, dyspnea, fatigue, and troponin elevation, would you recommend early initiation of high dose steroids for empiric treatment of ICI myocarditis while pursuing workup with coronary angiogram, echocardiogram, and/or cardiac MRI, or wait until alternative etiologies have been ruled out?
2 Answers available
Do you routinely start full dose anticoagulation in new onset atrial fibrillation in the ICU?
2 Answers available
Do you rule out TB in patients with AIDS and lobar pneumonia?
What’s your threshold to get the three AFBs and place the patient in airborne isolation?
1 Answer available
How would you approach a patient incidentally found to have PET avid large vessel vasculitis on CT angiogram during pre CABG workup?
Would you proceed with CABG procedure or treat the aortitis first?
1 Answer available
Do you transfuse platelets prior to central line placement in patients with platelet counts less than 50,000?
1 Answer available
Which clinical and echocardiographic parameters (i.e. LVEF, AVA) do you use when determining patient candidacy for LV device-assisted percutaneous balloon aortic valvuloplasty in patients with cardiogenic shock and severe AS?
1 Answer available
What would be a reasonable means of mechanical circulatory support as a bridge to AVR for patients with severe aortic regurgitation complicated by cardiogenic shock?
1 Answer available
What is your approach to PEEP titration in the management of a morbidly obese patient with ARDS?
1 Answer available
Do you routinely use inhaled pulmonary vasodilators in the management of patients with ARDS with refractory hypoxemia?
1 Answer available
Which hemodynamic parameters can be used to titrate positive pressure ventilation in preload dependent settings such as RV failure, cardiac tamponade, HOCM or hemodynamically significant PE?
2 Answers available
When should headache treatment be escalated to inpatient IV lidocaine?
There are some data supporting the use of IV lidocaine as an abortive treatment for migraine, NDPH, and some trigeminal autonomic cephalalgias, when d...
2 Answers available
Do you perform spontaneous breathing trials on higher levels of PEEP with extubation to positive pressure ventilation in patients intubated for obesity hypoventilation syndrome?
2 Answers available
Have you encountered acute kidney injury after starting eltrombopag for aplastic anemia as part of triple immunosuppressive regimen with ATG and cyclosporine?
1 Answer available
Is an early chest tube and tPA/Dornase therapy for a loculated and complex pleural effusion that is not an empyema or hemothorax helpful in reducing the rate of developing trapped lung?
1 Answer available
Do you start steroid therapy in a patient with pure ARDS without septic shock, or would you only consider steroids only in those with severe community acquired pneumonia?
To help interpret clinical applications of the CAPE COD (2023) and DEXA ARDS (2020) trials.
2 Answers available
Would you recommend initiating RRT in a patient with tumor lysis syndrome and a phosphorus of 9 mg/dl or more who does not have symptomatic hypocalcemia or other indications for dialysis?
1 Answer available
Do you typically recommend anti-epileptic medication in patients with acute multi-compartmental intracranial hemorrhage?
1 Answer available
Would you add an SGLT2 inhibitor to augment diuresis during a hospitalization in a patient with nephrotic syndrome, an eGFR above 30 mL/min/1.73m2, and refractory hypervolemia on an intravenous loop diuretic?
1 Answer available
Do you routinely continue using TPA/Dornase for treatment of empyema, if there is accumulation of new sero-sanguinous output from the chest tube after the initial treatment?
Are there any quantitative indices (eg. volume, pleural fluid hematocrit) that would impact your decision to stop subsequent TPA/dornase treatments?
1 Answer available
Is there a difference in treatment of status epilepticus from alcohol withdrawal vs other causes?
1 Answer available
What is a reasonable approach to monitoring mechanical valve function if systemic anticoagulation needs to be held in the setting of an acute intracranial hemorrhage?
1 Answer available
What is your threshold to start stress dose steroids in the management of patients with septic shock?
Do you do start therapy at a certain vasopressor requirement?
2 Answers available
Do you use tolvaptan for management of hyponatremia related to heart failure given the side effect profile and lack of mortality benefit seen in a previous trial?
The EVEREST Outcome trial (Konstam et al., PMID 17384437)
1 Answer available
What is your approach to the use of desmopressin prior to performing a kidney biopsy to potentially prevent procedural associated bleeding?
1 Answer available
What is your approach to the use of intravenous sodium thiosulfate for the management of calciphylaxis in a patient with end stage kidney disease and on hemodialysis?
1 Answer available
Do you recommend testing for G6PD deficiency in those with whom rasburicase for tumor lysis syndrome is indicated?
2 Answers available
What are some alternatives to dexamethasone for brain edema in patients who are allergic, have an intolerance, or refuse the medication?
5 Answers available
Do you proceed with outpatient hemodialysis for an asymptomatic ESKD patient who has missed the last three hemodialysis sessions?
1 Answer available
Do you prefer that hospitalized peritoneal dialysis patients use their own home dialysis equipment during the admission?
2 Answers available
How do you manage autonomic storming in patients with increased intracranial pressure?
1 Answer available
Under which clinical scenarios do you consider an inpatient EMG?
1 Answer available
In a patient hospitalized for several days with a refractory pain crisis would you ever consider transfusion, either simple or possibly exchange in an attempt to get the patient over the crisis?
2 Answers available
Do you recommend hydroxyurea in patients with sickle cell disease with hereditary persistence of fetal hemoglobin who have recurrent vaso-occlusive crises requiring hospital admission?
If hydroxyurea modifies the course of sickle cell disease by increasing fetal hemoglobin, is there any benefit to using it in patients with fetal hemo...
1 Answer available
Would you use PCC for clotting factor repletion in acute life threatening hemorrhage in a patient with elevated INR from coagulopathy of liver disease?
2 Answers available
How do you target therapy before the EEG is connected in a patient who comes to the ED in super refractory generalized convulsive status epilepticus once the convulsions resolve?
If the patient is in burst-suppression once EEG is connected, how long do you keep patient in burst-suppression before weaning sedation?
1 Answer available
Should we routinely incorporate iron studies into admissions for acute decompensated heart failure?
If so, how frequently should we measure iron saturation/ferritin levels post-iron infusion?
1 Answer available
What is your next step in management for a patient with immunotherapy induced pneumonitis that does not improve on high dose steroids for 48 hours?
How do you decide between starting infliximab, MMF, or IVIG? If a patient presents in respiratory failure (nearing or requiring intubation), woul...
1 Answer available
What blood pressure goals do you typically target for patients in the immediate post thrombectomy period?
2 Answers available
Are there situations where you would start treatment for cardiac amyloid in a patient with amyloid seen on biopsy, but still pending mass spectrometry results?
E.g. in a patient with tenuous cardiac function, would starting treatment several weeks earlier potentially improve outcomes?
1 Answer available
Under what conditions do you perform a post-procedural kidney ultrasound in patients who recently underwent a kidney biopsy?
1 Answer available
Do you require patients who undergo a kidney biopsy to be admitted to the hospital for observation?
1 Answer available
How do you approach treatment of septated parapneumonic pleural effusions that do not satisfy traditional criteria for complicated effusion after diagnostic thoracentesis?
Is there any role of tube thoracostomy as opposed to only antibiotics?
1 Answer available
Do you perform apnea testing prior to ancillary tests in patients with suspected brain death who are unable to undergo complete brainstem testing?
For patients who are unable to have complete brain stem testing, would you recommend apnea testing prior to ancillary tests in case of suspected brain...
2 Answers available
What is your stepwise approach to initiating GDMT in the inpatient setting for newly diagnosed HFrEF?
1 Answer available
Is there a preferred heart rate range for patients with moderate to severe paravalvular leak post-TAVR?
1 Answer available
Do you typically recommend inpatient stroke evaluation for patients with incidentally found asymptomatic stroke on outpatient imaging?
For patients undergoing outpatient MR imaging for other indications who have instantly found acute stroke, do you typically recommend the patient be a...
5 Answers available
What is your perspective on the role of respiratory therapists in managing a patient who is dyssynchronous on their current mode of mechanical ventilation?
Do your respiratory therapists independently adjust ventilator settings without direct physician involvement?
2 Answers available
What is your approach to weaning IABPs?
1 Answer available
Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?
How do you approach which risk to accept given that steroids have evidence for use in COVID-19 while is suggestion for harm in using steroids in influ...
1 Answer available
How do you approach treatment of myoclonic status epilepticus from anoxic brain injury?
Or love to share personal experiences/articles?
3 Answers available
How long do you wait before foley or IV placement in patients who have recieved TNK or TPA?
3 Answers available
Would you give pentoxiphylline and vitamin E during HBO for vaginal necrosis?
1 Answer available
How do you complete brain death testing in patients who cannot tolerate apnea testing and are unable to transport for ancillary testing?
For instance, if the patient doesn’t tolerate apnea testing, is too unstable to go for ancillary testing outside the ICU, and TCDs/EEG are unava...
5 Answers available
What steroid regimen do you employ prior to extubating a patient who does not have a suitable cuff leak?
2 Answers available
What steroid regimen do you use in patients with both septic shock and ARDS?
Do you use hydrocortisone 200 mg/day as studied in ADRENAL/APROCCHSS or dexamethasone 20 mg/day as studied in DEXA-ARDS?
2 Answers available
Is there any role for palliative radiation in patients who are intubated due to malignant airway obstruction?
Given the substantial risks associated with transporting an intubated and ventilated patient to Radiation Oncology, is there any evidence to support t...
5 Answers available
What is your approach to managing hypocalcemia following a parathyroidectomy in patients with end stage kidney disease?
1 Answer available
What precautions do you take prior to CABG in a patient with sickle cell trait?
Please comment on temperature recommendations and role of exchange transfusion. 
1 Answer available
How would you manage anti-platelet therapy in patients presenting with ischemic stroke and have a history of von Willebrand disease?
1 Answer available
How do you manage a patient with giant cell arteritis treated with weekly tocilizumab and low dose glucocorticoid who develops sudden vision loss?
2 Answers available
Would you give IV thrombolysis to a patient presenting with acute disabling stroke symptoms after a TAVI procedure?
1 Answer available
What is the appropriate management of severe myalgia during atezolizumab infusion?
1 Answer available
When do you start anticoagulation in patients with endocarditis and evidence of mycotic aneursym?
3 Answers available
What are your preferred ventilatory settings/mode(s) for patients with acute hypoxic respiratory failure presenting with severe biventricular dysfunction in cardiogenic shock?
1 Answer available
How would you approach the treatment of a patient who, during a hospitalization, was initially diagnosed with TTP and treated with PLEX with good response, but renal biopsy then resulted class IV LN along with changes of thrombotic microangiopathy?
4 Answers available
How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?
1 Answer available
Do you typically recommend four factor prothrombin complex concentrate versus fresh frozen plasma for INR correction in patients with vitamin K antagonist associated spontaneous ICH?
4 Answers available
How do you approach ictal-interictal continuum in patients with presumed toxic/metabolic etiology?
For example, a patient with 2 Hz GPDs with hepatic or uremic encephalopathy.
1 Answer available
Is angioedema secondary to IV tPA considered an absolute contraindication for tPA in future?
3 Answers available
Do you routinely use milrinone to augment RV function in patients with massive pulmonary emboli on vasoactive support?
1 Answer available
For a patient with PE undergoing procedures like port placement in the first month, how do you manage anticoagulation?
What is your preferred agent (DOAC, warfarin, enoxaparin), and is periprocedural bridging necessary?
3 Answers available
What is your approach to BK hemorrhagic cystitis not responding to cidofovir?
1 Answer available
When are steroids indicated in the treatment of strep pneumo meningitis?
Does timing relative to initiation of antibiotics matter?
1 Answer available
How do you evaluate and treat patients with cerebral edema secondary to hyperammonemia?
What modality do you prefer?
3 Answers available
Do you recommend pre-emptive anti-epileptic treatment for patients with spontaneous ICH?
If so, for how long?
3 Answers available
How do you manage grade 3 enterocolitis from 5FU mitomycin and pelvic radiotherapy?
C diff infection ruled out and CT abdomen pelvis shows diffuse enterocolitis extending far beyond the bowel-sparing IMRT radiotherapy field. 
2 Answers available
In what subset of traumatic brain injury/concussion patients would you consider use of N-Acetyl Cysteine?
2 Answers available
When do you redose IVIG in GBS patients who were under-treated and are worsening?
Is there any data supporting this?
2 Answers available
How do you manage MPN patients with acquired VWD in the perioperative setting?
Please specify your approach in elective and emergency surgical situations
1 Answer available
Do you perform a clamp trial before removing a chest tube for pneumothorax?
2 Answers available
Do you give intrapleural lytics for complicated effusion/empyema in patients on systemic anticoagulation?
1 Answer available
What patient related factors and hemodynamic parameters would lead you to avoid transbronchial biopsies in patients with pulmonary hypertension?
1 Answer available
Do you typically recommend platelet transfusions in patients with spontaneous ICH?
Do you have a particular cutoff?
2 Answers available
Do you ever employ the use of prolonged periods of pressure support ventilation as means of "weaning" in the management of patients with acute respiratory failure?
1 Answer available
Do you typically recommend CT angiogram and CT venogram to assess for patients with lobar spontaneous ICH?
2 Answers available
What is your institutional approach to a restrictive “neutropenic diet”?
3 Answers available
For a patient with high suspicion for NMDA receptor encephalitis, is there a role for giving rituximab along with methylprednisolone & IVIG (all three together) while the CSF anti-NMDAR antibodies are still pending?
Instead of waiting for the antibody test to result, if you have a high suspicion for NMDAR encephalitis, is there a role for giving rituximab alongsid...
1 Answer available
Do you always pursue stroke work up in patients diagnosed with transient global amnesia?
For patients clinically presenting with Transient Global Amnesia and no other focal neurologic deficits, do you always pursue work up to rule out stro...
8 Answers available
What is the preferred management plan for patients diagnosed with a concussion in the acute setting?
1 Answer available
Do you give IV fluids to avoid renal compromise in patients with inflammatory myositis with a CK over a certain threshold?
In the absence of rhabdomyolysis is there still a need to protect the kidneys when patients with inflammatory myositis have CK over 5000 or 10000?
1 Answer available
What protocols or safeguards do you implement if bed bugs are found on a patient or their belongings while on the treatment table or near equipment?
What precautions can be taken to limit infestation of the department?   Do you implement a treatment delay and if so how do you decide when...
2 Answers available
What criteria does your institution use to indicate patient is ready for PEG tube removal?
3 Answers available
Do you consider extensive clot burden as a factor in determining whether patients with submassive PE may be appropriate for thrombolytic therapy?
3 Answers available
What is your decision process on decreasing the sodium goal for patients with cerebral edema?
1 Answer available
In a life-time non-smoker with stage IV lung adenocarcinoma presenting in visceral crisis, what therapy would you recommend to avoid organ failure while awaiting mutational status?
1 Answer available
Do you recommend the use of endobronchial valves in the management of patients with spontaneous pneumothorax with persistent air leak?
1 Answer available
Are there certain sedatives or anti-epileptic meds to avoid in patients with IDD?
What are your thoughts on the ethics of inpatient use of sedatives in these patients to help with agitation to “protect themselves from harm and...
4 Answers available
How do you manage rectal or bowel perforation from interstitial brachytherapy needles?
2 Answers available
What is your approach for a patient with an acute ischemic stroke caused by an aortic thrombus?
2 Answers available
Can the tracheostomy be reversed after completion of chemoradiation for laryngeal cancers?
At what disease free interval is the safest to consider this?
1 Answer available
Do you recommend the use of indwelling pleural catheters in the management of patients with hepatic hydrothorax requiring frequent drainage?
1 Answer available
For patients with generalized tonic-clonic seizures lasting > 2 minutes without IV access, what alternative medications can be used?
1 Answer available
Do you routinely obtain an EEG in patients who are admitted with traumatic intra-cerebral hemorrhage?
3 Answers available
How do you manage acute exacerbations of trigeminal neuralgia?
What effective modalities have you found for acute exacerbations of trigeminal neuralgia including in patients who present to the ED? 
3 Answers available
For patients receiving outpatient venetoclax/azacitidine who develop profound neutropenia with ANC <200, do you admit for monitoring during the nadir in the absence of fever?
If not, what instructions do you give to patients regarding checking temperature at home/return precautions?
2 Answers available
What is your approach to a patient who has an ischemic stroke while on clopidogrel despite strict compliance and normal results on clopidogrel response assay?
5 Answers available
Do you employ the use of external chest compression with sandbags in the management of patients with severe ARDS who are not candidates for proning?
1 Answer available
When do you start anticoagulation in a patient with cardioembolic CVA secondary to new onset atrial fibrillation with hemorrhagic conversion?
1 Answer available
How do you determine timing and frequency of stability scans for a patient with spontaneous, non-aneurysmal intracerebral hemorrhage?
What factors influence your thinking?
1 Answer available
Do you recommend using IL-1/IL-6 inhibitors in COVID-19 multisystem inflammatory syndrome in adults (MIS-A)?
1 Answer available
When do you consider plasma exchange for multiorgan failure in a patient with sickle cell disease?
2 Answers available
Do you frequently encounter asterixis in patients with UTI associated encephalopathy?
The most frequently taught cause of asterixis is hepatopathy and of course hepatic encephalopathy, and has other close associations (ie, uremia), I ha...
2 Answers available
Do you use a combination of anticoagulant and antiplatelet therapy for treating intraluminal internal cerebral artery thrombus causing stroke?
For what duration do you use therapy?
1 Answer available
How do you approach the management of a large vessel stroke if you anticipate the development of malignant cerebral edema?
Is there any benefit to starting hyperosmolar therapy prior to the development of depressed level of consciousness or midline shift?
1 Answer available
Do you treat cerebral vein thrombosis with parenchymal hemorrhage using full dose heparin protocol rather than the high risk protocol?
1 Answer available
How do you manage drug-induced thrombocytopenia when the implicated drug is essential?
e.g. DITP from eptifibatide after a cardiac intervention
1 Answer available
What is your preferred anticoagulant for acute portal vein thrombosis?
How does cirrhosis and/or underlying thrombophilia affect your decision?
1 Answer available
Would you hold osimertinib in a patient with a STEMI, and for how long?
1 Answer available
Do you start anticoagulation in a patient with infective endocarditis who also has atrial fibrillation and stroke?
1 Answer available
How do you approach the use of endothelin receptor antagonists in patients with scleroderma renal crisis and hypertension refractory to maximum ACE inhibition and calcium channel blockers?
1 Answer available
How do you treat refractory focal status epilepticus in patients with traumatic bilateral subdural hematomas?
How do you treat refractory focal status epilepticus in an adult with history of alcoholism and traumatic bilateral subdural hematomas who is failing ...
1 Answer available
How do you prescribe Perampanel for use in patients with refractory status epilepticus?
What is the your preferred loading (and maintenance) dose for use of Perampanel in the treatment of refractory status epilepticus?
2 Answers available
What is your approach to treating severe manifestations of neuropsychiatric SLE in the setting of concomitant infection?
1 Answer available
When is follow-up imaging warranted in patients with anoxic brain injury?
What modality do you prefer?
1 Answer available
How would you approach treatment for fulminant RA-associated ILD?
Would you discontinue Methotrexate and TNF inhibitors even if previously no side effects from these medications, and would you consider Cyclophosphami...
1 Answer available
How do you approach management of newly diagnosed locally advanced NSCLC in patients who are intubated for respiratory failure due to their disease burden?
E.g. disease burden causing airway or vascular compression.
3 Answers available
How do you approach a medically inoperable patient with clinically stage 2 grade 1 endometrioid endometrial carcinoma with heavy vaginal bleeding that is refractory to EBRT and requiring inpatient management with transfusions?
1 Answer available
How do you treat patients with symptoms of acute ischemic stroke who have an allergic reaction to alteplase?
How would you treat patients with symptoms of AIS who have an allergic reaction to TPA with no evidence of large vessel occlusion on imaging? What nex...
1 Answer available
How do you approach infused prostacyclin therapy for critical digital ischemia?
What factors go into choosing the right patient and determining length of therapy?
1 Answer available
What is the maximum pRBC volume you can transfuse when performing a manual exchange transfusion in an adult-sized patient with sickle cell disease?
1 Answer available
In patients in the ICU who are on the inter-ictal continuum, how do you decide whether or not to treat for potential non-convulsive status epilepticus?
In patients undergoing continuous EEG monitoring in the ICU, we often encounter EEG patterns that lie along the inter-ictal continuum (IIC). In such c...
1 Answer available
Do you use premedications (acetaminophen, diphenhydramine) before pRBC and plt transfusions to prevent febrile nonhemolytic transfusion reactions and allergic reactions?
Does manipulation of blood products (leukoreduction, irradiated) affect your approach? There is growing evidence that routine premedication (at least ...
1 Answer available
How should a patient with perforated H. pylori negative gastric MALT be managed?
Should systemic therapy or ISRT be utilized?   Is there a risk for intrabdominal spread with perforation? If the ulcer is repaired by simple...
1 Answer available
What is your approach for a symptomatic inpatient with locally advanced NSCLC who cannot have a PET?
Would you consider treating the full mediastinum or any mildly enlarged nodes, even contralateral? Do you have a strategy that transitions from a pall...
2 Answers available
When do you consider starting hypertonic saline solution in patients with an acute ischemic stroke?
1 Answer available
How do you approach management of cerebral venous sinus thrombosis in a patient with severe thrombocytopenia?
1 Answer available
What is the transfusion management of a sickle cell patient during pregnancy?
What are your target goals during transfusion, either prophylactically or during acute complication? Does your management change between vaginal deliv...
1 Answer available
Is there a role for anti-fibrinolytic agents in patients with hyperfibrinolytic disseminated intravascular coagulation?
The use of anti-fibrinolytics is typically contraindicated in DIC, but does it have benefit in DIC states characterized by hyperfibrinolysis?
1 Answer available
How do you determine the timing of anticoagulation for patients with large MCA strokes secondary to atrial fibrillation?
1 Answer available
In what clinical settings is acute ICH clot removal recommended?
1 Answer available
What is your approach to platelet transfusion in heparin induced thrombocytopenia? 
Does having a concurrent consumptive process e.g. DIC change your management? 
1 Answer available
When can defibrotide be discontinued before the 21-day treatment course is completed in a pediatric patient with SOS?
Do you always treat with the full 21-day treatment course, or can defibrotide be stopped if certain criteria are met sooner?
1 Answer available
How would you manage a patient with antiphospholipid syndrome in the setting of severe steroid-refractory thrombocytopenia?
Especially in a triple-positive patient with an acute ischemic stroke who may have urgency for anticoagulation with high bleeding risk and severe thro...
2 Answers available
How would you treat non-secretory myeloma in an inpatient setting?
Does your management change based on the type of end-organ involvement at the time of diagnosis? Are there any reports of CNS involvement with non-se...
2 Answers available
What is your approach to treatment of lupus peritonitis?
1 Answer available
Are you recommending tocilizumab for any COVID-19 patients?
Current guidelines do not support its use, but the EMPACTA trial suggests it may be effective in a subpopulation of patients.
1 Answer available
How do you manage a delayed hemolytic transfusion reaction in a patient with sickle cell disease?
How do you manage an uncomplicated DHTFR versus a hyperhemolysis?
1 Answer available
How do you approach anticoagulation in patients with catastrophic antiphospholipid syndrome and thrombocytopenia?
1 Answer available
Would you place an IVC filter in a patient with an acute PE and an absolute contraindication for anticoagulation, but negative imaging for proximal DVT?
3 Answers available
How do you counsel patients regarding initiation of total parenteral nutrition (TPN) with malignant small bowel obstruction?
1 Answer available
What is the optimal VTE prophylaxis for hospitalized patients with COVID-19?
Should we use a different dose in critically ill patients in the ICU? When should we consider intermediate-dose anticoagulation?
1 Answer available
How would you treat a de novo CLL with WBC of 1,000,000 and no overt signs of leukostasis?
1 Answer available
Would you start a patient with sickle cell disease and COVID-19 on prophylactic anticoagulation?
0 Answers available
How would you manage newly diagnosed spinal cord compression presenting with paraplegia without tissue confirmation?
0 Answers available
Would you recommend anticoagulation for patients with partial false lumen thrombosis in type B aortic dissection?
Would you offer this routinely or only if specific complications arise, such as distal emboli?
2 Answers available
How would you treat a young patient with symptomatic Rosai-Dorfman disease who has recurrent, life-threatening pericardial and pleural effusions?
CT scans show omental and pelvic disease.
1 Answer available
How would you manage a patient with anal squamous cell carcinoma and 5 FU induced coronary vasospasm 36 hours after starting definitive chemoradiation?
No known cardiac risk factors 
3 Answers available
How do you manage a hemorrhage from a cavernous malformation following SRS?
1 Answer available
Would you recommend anticoagulation prophylaxis for a pediatric patient admitted with COVID-19?
3 Answers available
How would you manage a patient with sickle cell disease who is infected with COVID-19?
1 Answer available
Are you covering the tracheostomy site with a surgical mask due to COVID-19 to protect the therapist?
Please see this article for referrence https://www.sciencedirect.com/science/article/pii/S0167814020301638
1 Answer available
How should you manage a COVID-19 infected/suspected patient who is receiving chemotherapy and cannot interrupt or delay their cancer treatment?
2 Answers available
How should you manage a pediatric oncology patient who has an ANC > 500 and a normal chest x-ray but is confirmed to be infected with COVID-19 and is immunosuppressed from chemotherapy?
Should the patient be admitted for observation which will risk exposing other immunocompromised patients to COVID-19, or should the patient be quarant...
1 Answer available
Do you routinely use tumor lysis prophylaxis when starting chemotherapy for germ cell tumors?
How do you assess risk of tumor lysis syndrome, and is hydration sufficient or should hypouricemic agents be used as well?
2 Answers available
For inpatient treatment of lymphoma and ALL, can rituximab be delayed?
I.e., Can day 2 Rituximab (RCHOP) or day 6 Rituximab (DA-EPOCH, Hyper CVAD) be given? Or should only Day 1 Rituximab be used with chemoimmunotherapy i...
2 Answers available
How long after a tracheostomy would you wait before initiating RT?
1 Answer available
How would you manage palliation in a patient with postobstructive pneumonia caused by a mediastinal mass?
Would you treat if there is active infection?  How much improvement would you expect?
1 Answer available
What is your protocol for conscious sedation during T&O insertion?
What are your specific protocols for monitoring and for dosing narcotics and sedatives?
2 Answers available
What techniques do you use to treat patients who weigh more than the treatment table limit?
Place the patient partially on the table? Treat them on a hospital bed? Simply deny treatment until weight is reduced?
2 Answers available
Is SVC syndrome a medical emergency?
Is a biopsy needed? Do you consider treatment palliative or curative?
1 Answer available


Papers discussed in this category

Indian J Urol,
Severe acute tumor lysis syndrome in patients with germ-cell tumors.
Lung cancer (Amsterdam, Netherlands), 1994-03
Toxicity of thoracic radiotherapy on pulmonary function in lung cancer.
Lancet Oncol., 2020 Feb 14
Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.
Ann. Oncol., 2020 Mar 26
Clinical characteristics of COVID-19-infected cancer patients: A retrospective case study in three hospitals within Wuhan, China.
Hong Kong medical journal = Xianggang yi xue za zhi, 2003-12
Treatment of severe acute respiratory syndrome with lopinavir/ritonavir: a multicentre retrospective matched cohort study.
Lancet, 2020 Mar 04
Middle East respiratory syndrome.
Intensive Care Med, 2020 Mar 03
Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China.
Lancet, 2020 Jan 24
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
Int J Antimicrob Agents, 2020 Feb 17
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges.
Cell Res, 2020 Feb 04
Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
Biosci Trends, 2020 Jan 28
Drug treatment options for the 2019-new coronavirus (2019-nCoV).
Acta Paediatr., 2020 Mar 23
Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults.
N Engl J Med, 2020 Feb 13
Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis.
Blood, 2021 Apr 01
Real-world experience with caplacizumab in the management of acute TTP.
Clin Colorectal Cancer, 2018 Oct 10
Bolus 5-fluorouracil (5-FU) In Combination With Oxaliplatin Is Safe and Well Tolerated in Patients Who Experienced Coronary Vasospasm With Infusional 5-FU or Capecitabine.
Haematologica, 2020
Clinicopathological features, treatment approaches, and outcomes in Rosai-Dorfman disease.
Nature, 2019-03
Efficacy of MEK inhibition in patients with histiocytic neoplasms.
Blood, 2018 May 02
Consensus recommendations for the diagnosis and clinical management of Rosai-Dorfman-Destombes disease.
Leuk Lymphoma, 2019 Dec 26
Management and outcomes of sinus histiocytosis with massive lymphadenopathy (Rosai Dorfman Disease).
Blood, 2015-05-28
How I treat and manage strokes in sickle cell disease.
Blood Adv, 2020 Jan 28
American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support.
Blood, 2015 Aug 24
Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis.
Blood, 2015-10-29
Efficacy of transfusion with granulocytes from G-CSF/dexamethasone-treated donors in neutropenic patients with infection.
Lancet, 2016 May 10
Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial.
J Vasc Interv Radiol, 2020 Sep 09
Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine.
Journal of thrombosis and haemostasis : JTH, 2018-06-07
McMaster RARE-Bestpractices clinical practice guideline on diagnosis and management of the catastrophic antiphospholipid syndrome.
N Engl J Med, 2020 Dec 10
Efficacy of Tocilizumab in Patients Hospitalized with Covid-19.
N Engl J Med, 2020 Dec 17
Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia.
Ann Hematol, 2020 Apr 19
Clinical characteristics and outcomes of oligosecretory and non-secretory multiple myeloma.
Lancet (London, England), 2010-07-03
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial.
J Intensive Care, 2014 Feb 20
Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines.
Bone Marrow Transplant, 2019 Oct 01
Prophylactic, preemptive, and curative treatment for sinusoidal obstruction syndrome/veno-occlusive disease in adult patients: a position statement from an international expert group.
Front Immunol, 2020 Apr 03
Diagnosis and Treatment of VOD/SOS After Allogeneic Hematopoietic Stem Cell Transplantation.
Stroke, 2020 Aug 06
Anticoagulation Type and Early Recurrence in Cardioembolic Stroke: The IAC Study.
Pediatrics, 2015-02
Benefits of strict rest after acute concussion: a randomized controlled trial.
Stroke, 2015 May 28
Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.
Lancet Neurol, 2022 09
Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial.
Stroke, 2022 May 17
2022 Guideline for the Management of Patients With Spontaneous Intracerebral Hemorrhage: A Guideline From the American Heart Association/American Stroke Association.
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, 2010-02
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