IE is an infection of native or prosthetic heart valves, endocardial surface or an indwelling cardiac device (such as a pacer or defibrillator). In recent years, we’re seeing it happen in older and more chronically ill patients. And more MRSA.
The diagnosis is tricky because the presentation can be fairly subtle. You need a high index of suspicion, fever and:
- unclear infectious source
- new regurgitant murmur
- embolic events of unknown source
Get 3 sets of BCx in the ED before antibiotics and possibly a TTE. Patients should receive IV Abx and 1/2 of them require valve replacement or debridement surgery. Indications for surgery are:
- development of heart failure
- perivalvular abscess formation
- uncontrolled infxn
- Large, Mobile vegetations (that may flick off)
Continue reading “Infective Endocarditis”
In his book, Sönke Ahrens describes two things to improve writing productivity:
- Routines for writing
- A system for organizing notes and ideas
He breaks down the daunting task of writing by pointing out:
- Writing a book or manuscript would be easy if someone gave you the first draft.
- Writing the first draft would be easy if someone gave you an organized set of ideas.
- Generating the ideas would be easy if someone gave you a set of properly referenced notes from the literature.
Obviously, the “someone” in each of these scenarios is the same person. The routine comes from reversing the process, starting with taking a properly referenced set of notes – hence the title of the book. Continue reading “How to Take Smart Notes”
The importance of perseverance
Angela Duckworth’s work suggests that perseverance is a predictor of success. During her graduate student days she created a “grit scale” which she subsequently tested throughout her career. She characterized “grit” as working hard and finishing what one begins and gives the example of Will Smith explaining in an interview that if he was in a competention on a treadmill, there would be only two outcomes: he would be the last one running or he’d die on that treadmill because he “will not be out worked.”
Continue reading “True Grit: The Surprising, and Inspiring, Science of Success”