From Evidence to Practice: Managing Pain, Agitation and Delirium in the ICU

kamal-medlej

Dr. Kim Medlej

Kamal (Kim) Medlej, MD, is an attending physician at the department of emergency medicine at Massachusetts General Hospital and fellowship-trained in critical care, and a longtime contributor to MDCalc. Here’s Dr. Medlej’s take on applying evidence on managing pain, agitation, and delirium to his patients in the ICU.

Pain, agitation, and delirium (the ICU triad) are common in critically ill patients, and can be challenging for clinicians to manage, both in (1) ruling out and treating potential underlying causes, and (2) choosing appropriate sedatives and analgesics in those patients who need them.

This is a fascinating area of critical care medicine, although it can also be difficult and frustrating. While our insight and screening tools have improved, the management of patients with pain, agitation, and/or delirium remains difficult. This is a large topic with a significant amount of literature and opinions. This brief overview is in no way comprehensive, but more a personal view, approach and practice.

Continue reading “From Evidence to Practice: Managing Pain, Agitation and Delirium in the ICU”

The PEWS Score: Can an Algorithm Predict Worsening Illness in a Hospitalized Child?

By Jeff Russ, MD, PhD – Pediatric/Child Neurology Resident, UCSF

Dr. Jeff Russ

A major task of any pediatric ward provider is to regularly assess a patient’s appearance, vital signs, labs, and risk factors, and integrate these data into a cohesive clinical picture to determine the patient’s acuity and potential need for intervention. This can be especially challenging on busy services or night shifts, where, for example, nurses may divide their time among up to four patients, and a single physician may care for 10–20 patients. Particularly with children, a lot can change between sporadic assessments, making it difficult to triage acuity.

Continue reading “The PEWS Score: Can an Algorithm Predict Worsening Illness in a Hospitalized Child?”

300

We’ve just hit 300 calculators on our website (and iPhone and Android apps), and we thought it might be a good time for reflection.

By the Numbers:

  • The Los Angeles Motor Scale (LAMS) was our 300th calculator!
  • We’ve added over 120 calculators in the past year alone.
  • MDCalc has been around for 12 years.
  • We estimate that we’ve helped with over 15 million patient decisions across the world through our calculators and content in 2016.
  • We’re used in 210 countries.
  • Despite only having been prospectively validated in 2013, the HEART Score is already our 6th most popular calculator.
  • We receive about 5 new calculator requests per week.
  • We have 46 featured interviews with calculator creators that give insight into their thinking about their own scores.
  • We provide calculators for 50+ specialties.
  • We are used by at least 75% of US medical students in their clinical rotations.

Continue reading “300”

Heads Up on Head Injury Algorithms: The Cost of High Sensitivity

By Jeff Russ, MD, PhD – Pediatric/Child Neurology Resident, UCSF

Jeff Russ Headshot BW

Dr. Jeff Russ

Children presenting with head injury are as unremitting in children’s hospitals as the “Frozen” soundtrack, and any physician in a pediatric ED inevitably manages their fair share. The ramifications of missing significant injury to a child’s delicate, developing brain are unnerving. A head CT is central to catching intracranial pathology, but widespread use is not benign, given the risk of malignancy from unnecessary radiation. However, criteria for judiciously navigating this tradeoff remain debated. When is CT appropriate for children with GCS scores of 13-15 and mild symptoms like transient loss of consciousness or vomiting?
Continue reading “Heads Up on Head Injury Algorithms: The Cost of High Sensitivity”

Our Favorite Reads So Far in 2017

When the MDCalc team isn’t scouring PubMed for studies to help our patients (and yours), we also like to read other stuff related to digital health, evidence, and the healthcare industry. It’s always hard to keep up with all the interesting articles on healthcare, and this year medicine has been a popular topic for journalists. So, we thought we’d share some of our favorite articles. Happy reading!

On Digital Health

  1. A.I. VERSUS M.D. What happens when diagnosis is automated? – By Siddhartha Mukherjee, The New Yorker
  2. NHS to start prescribing health apps that help manage conditions – By Matt Reynolds, New Scientist
  3. A digital revolution in health care is speeding upThe Economist
  4. Future challenges for digital healthcare – By Linda Brookes, M.Sc., Medical News Today
  5. Bypassing Clinical Decision Support Tools for Imaging in the ED – By Hossein Jadvar, Medscape

On Evidence Continue reading “Our Favorite Reads So Far in 2017”

Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score

The CHA2DS2-Vasc Score is one of the most widely-used clinical risk scores for stroke. It’s arguably the best validated and is consistently in the top five most popular calcs on MDCalc. Professor Gregory Lip, the newest member of MDCalc’s Scientific Advisory Board, gave us an interview on developing and using the CHA₂DS₂-VASc Score.

dr-gregory-lip.jpeg

Dr. Gregory Lip

Why did you develop the CHA₂DS₂-VASc Score? Was there a clinical experience that inspired you to create this tool for clinicians?

The availability of Non-Vitamin K Antagonist Oral Anticoagulants (NOACs), previously referred to as new or novel oral anticoagulants, has led to a major change in the landscape for stroke prevention in atrial fibrillation (AF). Clinicians are also getting better at understanding how to manage warfarin, recognizing the importance of the average time in therapeutic range (TTR). New data are also re-emerging on the poor evidence for the efficacy and safety of aspirin for stroke prevention in AF. Continue reading “Insights from Dr. Gregory Lip, Creator of the CHA2DS2-VASc Score”

Insights from Dr. Christopher Seymour, Creator of the qSOFA Score

Ah, sepsis. You can’t solve a problem without defining it, and sepsis has been notoriously difficult to define, let alone treat. The body of data on sepsis is growing, as well as laypeople’s awareness of the disease. Yet it still manages to elude clinicians in many ways. We talked to Dr. Christopher Seymour, Sepsis-3 investigator and creator of the qSOFA Score, about using qSOFA to help in the management of sepsis.

Bonus: We also asked Dr. Seymour about his thoughts on vitamin C in sepsis. Come back to Paging MDCalc next week to see what he (and other critical care docs) had to say! Continue reading “Insights from Dr. Christopher Seymour, Creator of the qSOFA Score”

Tricks Up our New Website’s Sleeve: Version 3.1 is Here!

After a lot of hard work from MDCalc’s development team, we released Version 3.0 of MDCalc.com in January and just this past weekend we launched a few updates with Version 3.1. The new site offers a lot of great new features and customization that make using MDCalc even easier. Let’s jump into it! Continue reading “Tricks Up our New Website’s Sleeve: Version 3.1 is Here!”

Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE

The Padua Prediction Score is one of several validated venous thromboembolism (VTE)-related risk scores. It’s particularly useful in helping to determine whether hospitalized inpatients, who often have multiple comorbidities and thus multiple VTE risk factors, would benefit from pharmacologic prophylaxis over mechanical prophylaxis. We interviewed the first author on the derivation study, Dr. Sofia Barbar, for her insights on developing and using the Padua Prediction Score. Continue reading “Insights from Dr. Sofia Barbar – Creator of the Padua Prediction Score for Risk of VTE”