Joanne, Pedro e João trazem mais uma versão do Polêmicas do Sepse, logo depois da nova publicação do Surviving Sepsis! Nesse episódio mencionamos: 1) Escolha e tempo de antibioticoterapia 2) Qual solução para expansão volêmica e a quantidade necessária 3) Qual droga vasoativa realizar e como fazer E por último, a indicação de bicarbonato na sepse!  Referências em breve.

Ta de Clinicagem

Episódio 111: Polêmicas da Sepse - Atualizações

O uso da Varfarina é extremamente comum na nossa prática clínica e precisamos saber como manejar sua intoxicação. Kaue e Rapha conversam sobre essa intoxicação em 3 situações - Paciente com sangramento grave, sangramento leve e o paciente com RNI (ou INR) alterado mas sem sangramento. Referências: Crowther MA, Ageno W, Garcia D, et al. Oral vitamin K versus placebo to correct excessive anticoagulation in patients receiving warfarin: a randomized trial. Ann Intern Med 2009; 150:293. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Adv 2018; 2:3257. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:160S. Leissinger CA, Blatt PM, Hoots WK, Ewenstein B. Role of prothrombin complex concentrates in reversing warfarin anticoagulation: a review of the literature. Am J Hematol 2008; 83:137. Gunther KE, Conway G, Leibach L, Crowther MA. Low-dose oral vitamin K is safe and effective for outpatient management of patients with an INR>10. Thromb Res 2004; 113:205. Farrow GS, Delate T, McNeil K, et al. Vitamin K versus warfarin interruption alone in patients without bleeding and an international normalized ratio > 10. J Thromb Haemost 2020; 18:1133. Refaai MA, Goldstein JN, Lee ML, et al. Increased risk of volume overload with plasma compared with four-factor prothrombin complex concentrate for urgent vitamin K antagonist reversal. Transfusion 2015; 55:2722. Goldstein JN, Refaai MA, Milling TJ Jr, et al. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet 2015; 385:2077. Hylek EM, Regan S, Go AS, et al. Clinical predictors of prolonged delay in return of the international normalized ratio to within the therapeutic range after excessive anticoagulation with warfarin. Ann Intern Med 2001; 135:393. Kuijer PM, Hutten BA, Prins MH, Büller HR. Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med 1999; 159:457. 

TdC em Bolus - Como Manejar Intoxicação por Varfarina

Iago, Joanne e Pedro convidam Dr. Igor Pietrobom para falar sobre abordagem inicial no PS e investigação ambulatorial de litíase. Referências em breve.

Episódio 110: Litíase renal - do PS ao ambulatório feat Dr. Igor Pietrobom

Fred, Kaue e Luísa conversam um pouco sobre Infecção de Corrente Sanguínea Associada ao Cateter - Como diagnosticar? Como fazer antibioticoterapia? Quando investigar complicações? Como manejar Cateter de Longa Permanência? Comenta com a gente o que achou e o que ficou de fora lá nas nossas redes sociais @tadeclinicagem! Referências: Diretrizes: Manian FA. IDSA guidelines for the diagnosis and management of intravascular catheter-related bloodstream infection. Clin Infect Dis. 2009 Dec 1;49(11):1770-1; author reply 1771-2. doi: 10.1086/648113. PMID: 19891568. Chaves F. Diagnosis and treatment of catheter-related bloodstream infection: Clinical guidelines of the Spanish Society of Infectious Diseases and Clinical Microbiology and (SEIMC) and the Spanish Society of Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). Med Intensiva (Engl Ed). 2018 Jan-Feb;42(1):5-36. Cultura de Sangue do Cateter: Orihuela-Martín J, Rodríguez-Núñez O, Morata L, et al. Performance of differential time to positivity as a routine diagnostic test for catheter-related bloodstream infections: a single-centre experience. Clin Microbiol Infect 2020; 26:383.e1. Bouzidi H, Emirian A, Marty A, et al. Differential time to positivity of central and peripheral blood cultures is inaccurate for the diagnosis of Staphylococcus aureus long-term catheter-related sepsis. J Hosp Infect 2018; 99:192. Freeman JT, Elinder-Camburn A, McClymont C, et al. Central line-associated bloodstream infections in adult hematology patients with febrile neutropenia: an evaluation of surveillance definitions using differential time to blood culture positivity. Infect Control Hosp Epidemiol 2013; 34:89. Diagnóstico pela Ponta do Cateter: Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis. 2015 Feb 1;60(3):492-3. doi: 10.1093/cid/ciu845. Epub 2014 Oct 29. PMID: 25355902. Peterson LR, Smith BA. Nonutility of catheter tip cultures for the diagnosis of central line-associated bloodstream infection. Clin Infect Dis 2015; 60:492. Cateter Arterial e Cateter Periférico: Mermel LA. Short-term Peripheral Venous Catheter-Related Bloodstream Infections: A Systematic Review. Clin Infect Dis. 2017 Oct 30;65(10):1757-1762. Chopra V, O'Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. doi: 10.1086/671737. O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med. 2014 Jun;42(6):1334-9. Sítios e Risco Infeccioso: Parienti JJ, du Cheyron D, Timsit JF, et al. Meta-analysis of subclavian insertion and nontunneled central venous catheter-associated infection risk reduction in critically ill adults. Crit Care Med 2012; 40:1627. Deshpande KS, Hatem C, Ulrich HL, et al. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005; 33:13. Ge X, Cavallazzi R, Li C, et al. Central venous access sites for the prevention of venous thrombosis, stenosis and infection. Cochrane Database Syst Rev 2012; :CD004084.

Episódio 109: Infecção de Corrente Sanguínea Associada ao Cateter

Síncope no pronto-socorro é sempre um bom tema, já que pode ser algo simples até algo grave, e a decisão de internar ou não é um dos pilares da discussão dessa síndrome. Pedro e Fred discutem nesse bolus, quais os pontos principais a serem considerados nesse cenário! Referências em breve

TdC em Bolus - Quando internar um paciente por síncope?

Pedro, Guilherme e João se reunem novamente com o dr. José Carlos para falar de infarto sem supradesnivelamento de segmento ST! Um tema com mudanças recentes e cheio de dúvidas! Qual o melhor antiplaquetário depois do AAS? Fazer na sala de emergência ou na hemodinâmica? E o restante da prescrição? Qual a melhor hora pra fazer o cateterismo? Isso e muito mais nesse episódio! REFERÊNCIAS 1. COLLET, Jean-Philippe et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European heart journal, v. 42, n. 14, p. 1289-1367, 2021. 2. NICOLAU, José Carlos et al. Diretrizes da Sociedade Brasileira de Cardiologia sobre Angina Instável e Infarto Agudo do Miocárdio sem Supradesnível do Segmento ST–2021. Arquivos Brasileiros de Cardiologia, v. 117, p. 181-264, 2021. 3. SCHÜPKE, Stefanie et al. Ticagrelor or prasugrel in patients with acute coronary syndromes. New England Journal of Medicine, v. 381, n. 16, p. 1524-1534, 2019. 4. COMMIT (CLOPIDOGREL AND METOPROLOL IN MYOCARDIAL INFARCTION TRIAL) COLLABORATIVE GROUP et al. Early intravenous then oral metoprolol in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. The Lancet, v. 366, n. 9497, p. 1622-1632, 2005. 5. KUBICA, Jacek et al. Morphine delays and attenuates ticagrelor exposure and action in patients with myocardial infarction: the randomized, double-blind, placebo-controlled IMPRESSION trial. European heart journal, v. 37, n. 3, p. 245-252, 2016. 6. HOBL, Eva-Luise et al. Morphine decreases clopidogrel concentrations and effects: a randomized, double-blind, placebo-controlled trial. Journal of the American College of Cardiology, v. 63, n. 7, p. 630-635, 2014. 7. MEINE, Trip J. et al. Association of intravenous morphine use and outcomes in acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. American heart journal, v. 149, n. 6, p. 1043-1049, 2005. 8. ANDERSON, H. Vernon et al. One-year results of the Thrombolysis in Myocardial Infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. Journal of the American College of Cardiology, v. 26, n. 7, p. 1643-1650, 1995. 9. ABUZAID, Ahmed et al. Oxygen therapy in patients with acute myocardial infarction: a systemic review and meta-analysis. The American journal of medicine, v. 131, n. 6, p. 693-701, 2018.

Episódio 108: Infarto Sem Supra de Segmento ST

Fred e Pedro discutem um caso do João de Dor Abdominal! Uma das principais queixas do PS! Comenta com a gente o que achou e o que ficou de fora lá nas nossas redes sociais @tadeclinicagem! Referências CARTWRIGHT, Sarah L.; KNUDSON, Mark P. Evaluation of acute abdominal pain in adults. American family physician, v. 77, n. 7, p. 971-9778, 2008. LYON, Corey; CLARK, Dwayne C. Diagnosis of acute abdominal pain in older patients. American family physician, v. 74, n. 9, p. 1537-1544, 2006. CLAIR, Daniel G.; BEACH, Jocelyn M. Mesenteric ischemia. New England Journal of Medicine, v. 374, n. 10, p. 959-968, 2016. http://getthediagnosis.org/diagnosis/Appendicitis.htm http://getthediagnosis.org/diagnosis/Cholecystitis.htm ROSS, James T.; MATTHAY, Michael A.; HARRIS, Hobart W. Secondary peritonitis: principles of diagnosis and intervention. Bmj, v. 361, 2018. SRINIVASAN, Radhika; GREENBAUM, David S. Chronic abdominal wall pain: a frequently overlooked problem: practical approach to diagnosis and management. The American journal of gastroenterology, v. 97, n. 4, p. 824-830, 2002. 

Episódio 107: Caso Clínico de Dor Abdominal

João e Pedro trazem no bolus dessa semana, uma revisão rápida sobre Síndrome de Realimentação: como é feito o diagnóstico, em quem pensar, quais os cuidados e como tratar!  Referências em breve.

TdC em Bolus - Síndrome de Realimentação

- Quem deve fazer? - Até quando? - Como fazer? - O que fazer quando o resultado vem alterado? Rapha, Joanne e Iago respondem essas e outras perguntas! E ainda dão um bônus sobre as síndromes familiares, Polipose Adenomatosa Familiar (PAF) e Síndrome de Lynch Referências: 1- Screening for colorectal cancer: Strategies in patients at average risk. Uptodate Agosto 2021. Author:Chyke Doubeni, MD, FRCS, MPHSection Editors:Joann G Elmore, MD, MPHJ Thomas Lamont, MDDeputy Editor:Jane Givens, MD 2- USPSTF Recommendation: Screening for Colorectal Cancer. Entrevista do Jama, disponível em https://edhub.ama-assn.org/jn-learning/audio-player/18612046 3- DAVIDSON, Karina W. et al. Screening for colorectal cancer: US Preventive Services Task Force recommendation statement. JAMA, v. 325, n. 19, p. 1965-1977, 2021. 4- NEE, Judy; CHIPPENDALE, Ryan Z.; FEUERSTEIN, Joseph D. Screening for colon cancer in older adults: risks, benefits, and when to stop. In: Mayo Clinic Proceedings. Elsevier, 2020. p. 184-196. 5- http://cancerscreening.eprognosis.org/ 6- Shaukat et al. ACG Clinical Guidelines: Colorectal Cancer Screening 2021, The American Journal of Gastroenterology, vol. 116, n. 3 - p. 458-479, March 2021.

Episódio 106: 4 Clinicagens de Rastreio de Câncer Colorretal

Joanne e João recebem o dr. Júlio César para falar sobre um tema super importante: racismo e saúde da população negra! Qual o impacto do racismo na população e no sistema de saúde? Por quais vetores o racismo se expressa? Quais estratégias para reduzir esse problema? Isso e muito mais nesse episódio! LINK PARA O TESTE DE ASSOCIAÇÃO IMPLÍCITA https://implicit.harvard.edu/implicit/takeatest.html REFERÊNCIAS: 1. DEVINE, Patricia G. et al. Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. Journal of experimental social psychology, v. 48, n. 6, p. 1267-1278, 2012. 2. CUNNINGHAM, William A.; PREACHER, Kristopher J.; BANAJI, Mahzarin R. Implicit attitude measures: Consistency, stability, and convergent validity. Psychological science, v. 12, n. 2, p. 163-170, 2001. 3. GREEN, Alexander R. et al. Implicit bias among physicians and its prediction of thrombolysis decisions for black and white patients. Journal of general internal medicine, v. 22, n. 9, p. 1231-1238, 2007. 4. COOPER, Lisa A. et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. American journal of public health, v. 102, n. 5, p. 979-987, 2012. 5. DASGUPTA, Nilanjana; GREENWALD, Anthony G. On the malleability of automatic attitudes: combating automatic prejudice with images of admired and disliked individuals. Journal of personality and social psychology, v. 81, n. 5, p. 800, 2001. 6. Brasil. Ministério da Saúde (MS). Política Nacional de Saúde Integral da População Negra: Uma Politica do SUS. 3a edição. Brasília: MS; 2017 7. EVANS, Michele K. et al. Diagnosing and treating systemic racism. 2020. 8. BAILEY, Zinzi D.; FELDMAN, Justin M.; BASSETT, Mary T. How structural racism works—racist policies as a root cause of US racial health inequities. 2021. 9. PALLOK, Kristen; DE MAIO, Fernando; ANSELL, David A. Structural racism—a 60-year-old black woman with breast cancer. New England Journal of Medicine, v. 380, n. 16, p. 1489-1493, 2019. 10. MAIN, Elliott K. et al. Reduction in racial disparities in severe maternal morbidity from hemorrhage in a large-scale quality improvement collaborative. American journal of obstetrics and gynecology, v. 223, n. 1, p. 123. e1-123. e14, 2020. 11. WHITTLE, Jeff et al. Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. New England Journal of Medicine, v. 329, n. 9, p. 621-627, 1993. 12. TEAL, Cayla R. et al. Helping medical learners recognise and manage unconscious bias toward certain patient groups. Medical education, v. 46, n. 1, p. 80-88, 2012.

Episódio 105 - Racismo e saúde da população negra feat. dr. Júlio César

Mais um bolus! Pedro e João vieram dessa vez para falar de como é feito o diagnóstico de artrite reumatoide e assim conhecendo um pouco mais sobre a doença. Minutagem e Referências em breve.

TdC em Bolus - Diagnóstico de Artrite Reumatóide

Iago e Pedro discutem um caso de Plaquetopenia apresentado pelo Fred! Como confirmar a plaquetopenia? O que pedir de exame? Tudo isso nesse episódio!  Referências e Minutagem em breve

Episódio 104: Caso Clínico de Plaquetopenia

Kaue e Raíza discutem um caso de monoartrite aguda apresentado pelo Iago. Quais as causas mais importantes no pronto-socorro? Como iniciar a investigação? O que pedir no líquido sinovial? Referências: Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007;297(13):1478-1488 Sack K. Monarthritis: differential diagnosis. Am J Med 1997; 102:30S. Mohana-Borges AV, Chung CB, Resnick D. Monoarticular arthritis. Radiol Clin North Am 2004; 42:135. Shmerling RH, Delbanco TL, Tosteson AN, Trentham DE. Synovial fluid tests. What should be ordered? JAMA 1990; 264:1009. McCutchan HJ, Fisher RC. Synovial leukocytosis in infectious arthritis. Clin Orthop Relat Res 1990; :226. Siva C, Velazquez C, Mody A, Brasington R. Diagnosing acute monoarthritis in adults: a practical approach for the family physician. Am Fam Physician. 2003 Jul 1;68(1):83-90. PMID: 12887114. Becker JA, Daily JP, Pohlgeers KM. Acute Monoarthritis: Diagnosis in Adults. Am Fam Physician. 2016 Nov 15;94(10):810-816. PMID: 27929277. Jeong H, Kim AY, Yoon HJ, et al. Clinical courses and predictors of outcomes in patients with monoarthritis: a retrospective study of 171 cases. Int J Rheum Dis. 2014;17(5):502–510. Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: what is the cause of my patient's painful swollen joint? CMAJ. 2009;180(1):59–65. Baker DG, Schumacher HR Jr. Acute monoarthritis. N Engl J Med. 1993;329(14):1013–1020. Kienhorst LB, Janssens HJ, Fransen J, Janssen M; British Society for Rheumatology. The validation of a diagnostic rule for gout without joint fluid analysis: a prospective study. Rheumatology (Oxford). 2015;54(4):609–614. Bardin T. Gonococcal arthritis. Best Pract Res Clin Rheumatol. 2003;17(2):201–208.

Episódio 103: Caso Clínico de Monoartrite Aguda

TdC em Bolus - Quando usar o BNP

Rapha, Raíssa e João conversam sobre Osteoporose! Como diagnosticar? Qual é o manejo correto? Referências: 1- Overview of the management of osteoporosis in postmenopausal women. Uptodate 2021. Harold N Rosen, Marc K Drezner, Clifford J Rosen, Kenneth E Schmader, Jean E Mulder. 2- EASTELL, Richard et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, v. 104, n. 5, p. 1595-1622, 2019. 3- CAMACHO, Pauline M. et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis—2020 update. Endocrine Practice, v. 26, p. 1-46, 2020. 4- KANIS, John A. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis international, v. 30, n. 1, p. 3-44, 2019. 5- BLACK, DM; et al. Postmenopausal Osteoporosis. NEJM, 2016 6- SHANE, E; et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research, JBMR, Vol. 29, Nº1, 2014. 7- PEREZ, AD; et al. Treatment failure in osteoporosis, Osteoporos Int, 2012. 8- ADLER, RA; et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. JBMR, Vol. 31, Nº 1, 2016. 9- - BLACK, DM; et al. Postmenopausal Osteoporosis. NEJM, 2016 - AACE/ACE Clinical Practice Guidelines for the diagnosis and Treatment of Postmenopausal Osteoporosis - 2020 Update. 10- - SHANE, E; et al. Atypical Subtrochanteric and Diaphyseal Femoral Fractures: Second Report of a Task Force of the American Society for Bone and Mineral Research, JBMR, Vol. 29, Nº1, 2014. 11- PEREZ, AD; et al. Treatment failure in osteoporosis, Osteoporos Int, 2012. 12- ADLER, RA; et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. JBMR, Vol. 31, Nº 1, 2016.

Episódio 102: Osteoporose

Informação e descontração dentro da clínica médica/medicina interna! Voltado para médicos, estudantes de medicina e outros profissionais de saúde, com o objetivo de discutir temas importantes da área.

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Ta de Clinicagem

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