We are in an outbreak of RSV

1) Isolation recommended - CDC guidelines
https://webvpn.mcgill.ca/http/www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm

"Patient placement in acute-care facilities

1) Place a patient with diagnosed RSV, parainfluenza, adenovirus, or other viral respiratory tract infection in a private room when possible or in a room with other patients with the same infection and no other infection (IB) (37,367--369, 376,377).
2) Place a patient with suspected RSV, parainfluenza, adenovirus, or other viral respiratory tract infection in a private room (II).

a) Promptly perform rapid diagnostic laboratory tests on patients who are admitted with or who have symptoms of RSV infection after admission to the health-care facility to facilitate early downgrading of infection-control precautions to the minimum required for each patient's specific viral infection (IB) (364,376).
b) Promptly perform rapid diagnostic laboratory tests on patients who are admitted with or who have symptoms of parainfluenza or adenovirus infection after admission to the health-care facility to facilitate early downgrading of infection-control precautions to the minimum required for each patient's specific viral infection and early initiation of treatment when indicated (II)."

So -- I personally would isolate all RSV (or cohort).

2)Disease outcome of RSV in elderly is similar to that of non pandemic influenza (NEJM 2005)
https://webvpn.mcgill.ca/http/www.ncbi.nlm.nih.gov/pubmed/15858184

Wernicke's makes an appearance

Interesting case of real deal Wernicke's encephalopathy.

I hadn't previously appreciated the controversy around the ideal thiamine dose (ref) and I'm happy to be corrected about the dogmatic but not true "thiamine before glucose" in the comatose patient.

Preventing Hospital Acquired Disability

Part of my further quest to improve the care of elderly patients -- this article is a must read. I particularly believe in the restriction of delerium inducing medications, the ambulate 3-4 times a day prescription (rather than AAT), and the wearing of clothes...

Those of you who have heard my "patients should wear pants unless they have a problem in the pants area" routing will appreciate where I am coming from.

Consult Service - October 18

1) Wow...  Triglycerides of 67mmol/L -- can't say I've seen that before -- and in a patient with mild pancreatitis.  Hence this article on the use of insulin infusion to treat severe hypertriglyceridemia and a review on options in pancreatitis caused by hypertriglyceridemia.  

Consult Service - October 17

We talked about a lot of things today.  Many have previously been blogged about -- I believe the search actually works now.

One topic we discussed, which I haven't touched on before was Warfarin Induced Skin Necrosis (this is a helpful review).

Causing harm through quality improvement...

Primum non nocere

This article discusses developing quality measures to offset the unintended harms that come with more aggressive attempts to reach quality benchmarks for therapy (i.e. hypertension).

Time Limited Trials

Decisions about end of life care is patients with significant comorbid illness is challenging.  This article is worth a read...  Time limited intervention plans.