Landmark trials
Every paper cited on the cards, with a ward-level takeaway. Tap a row for the full summary and a link to the article.
- 2025GOLD 2025
Global Initiative for Chronic Obstructive Lung Disease strategy report
GOLD Science Committee
GOLD A = one bronchodilator, B = LAMA+LABA, E = dual ± ICS based on eosinophils and exacerbations.
- 2025NEJM 2025;392:1710
Mepolizumab in COPD with eosinophilic phenotype
Mepolizumab COPD investigators
Eosinophilic COPD now has more than one biologic — phenotype before you prescribe.
- 2025NEJM 2025;392:2193
Nerandomilast in idiopathic pulmonary fibrosis
Maher TM et al.
IPF antifibrotic menu now includes a PDE4B inhibitor — still not a cure; transplant referral remains at diagnosis.
- 2024Circ 2024;149:e1239
2024 AHA/ACC guideline for hypertrophic cardiomyopathy
Ommen SR, Ho CY, Asif IM, et al.
HOCM hypotension: phenylephrine, fluids, avoid inotropes/vasodilators. Myosin inhibitors are the new medical septal-reduction path.
- 2024AJG 2024;119:2
ACG guideline on Helicobacter pylori treatment
Chey WD, Howden CG, Moss SF, et al.
H. pylori: bismuth quadruple × 14 days, then test of cure. Do not empirically use clarithromycin triples.
- 2024NEJM 2024;391:5
Anti-nephrin autoantibodies in minimal change disease
Hengel FE, Dehde S, Lassé M, et al.
Adult MCD is often autoimmune (anti-nephrin) — still a steroid-first disease, but the biology is no longer ‘idiopathic only’.
- 2024NEJM 2024;391:1475
Finerenone in heart failure with mildly reduced or preserved ejection fraction (FINEARTS-HF)
Solomon SD, McMurray JJV, Vaduganathan M, et al.
Finerenone is a new HFpEF/HFmrEF option when an MRA is indicated and hyperkalemia risk is managed.
- 2024GINA 2024
Global Strategy for Asthma Management and Prevention
Global Initiative for Asthma
Never prescribe LABA without ICS. Prefer ICS-formoterol as both controller and reliever.
- 2024CID 2024;ciae403
IDSA guidance on the treatment of antimicrobial-resistant gram-negative infections
Tamma PD, Heil EL, Justo JA, et al.
Enterobacter in the blood is not a ceftriaxone organism. ESBL bacteremia gets a carbapenem.
- 2024JAMA 2024;331:1655
Interstitial lung disease — a review
Wijsenbeek MS, Suzuki A, Maher TM
Velcro crackles + restriction + low DLCO → HRCT and a multidisciplinary ILD discussion, not empiric steroids for presumed IPF.
- 2024KDIGO 2024
KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease
KDIGO CKD Work Group
CKD care is GFR × albuminuria. ACE/ARB + SGLT2i ± finerenone is the modern diabetic CKD stack.
- 2024Ann Hepatol 2024;29:101133 / AASLD guidance
MASLD/MASH nomenclature and management
Rinella ME et al. / Latin American and global consensus updates
MASLD is a metabolic disease — treat obesity, diabetes, and alcohol, not just the ALT.
- 2024NEJM 2024;390:1382
Microaxial flow pump or standard care in infarct-related cardiogenic shock (DanGer Shock)
Møller JE, Engstrøm T, Jensen LO, et al.
For STEMI shock, think early mechanical support rather than stacking inotropes — complications are real, so pick patients carefully.
- 2023Hepatology 2023;78:1922
AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma
Singal AG, Llovet JM, Yarchoan M, et al.
Every cirrhotic needs a 6-month HCC screen. A new liver lesion is not a ‘follow-up in a year’ situation.
- 2023ASH 2023 guidelines
ASH guidelines for thrombophilia testing
American Society of Hematology
If the result will not change the anticoagulant or duration, do not send the panel.
- 2023NEJM 2023;389:205
Dupilumab for COPD with type 2 inflammation (BOREAS)
Bhatt SP, Rabe KF, Hanania NA, et al.
Eos ≥300 COPD exacerbators on dual/triple: consider dupilumab (and mepolizumab in 2025 data).
- 2023NEJM 2023;389:975
Ferric carboxymaltose in heart failure with iron deficiency (HEART-FID)
Mentz RJ, Garg J, Rockhold FW, et al.
IV iron remains indicated in HFrEF with ferritin <100 or 100–300 + TSAT <20% even after HEART-FID’s mixed primary endpoint.
- 2023NEJM 2023;388:1931
Hydrocortisone in severe community-acquired pneumonia (CAPE COD)
Dequin PF, Meziani F, Quenot JP, et al.
For ICU-level severe CAP (not influenza), start hydrocortisone 200 mg/day — ATS now recommends steroids in severe CAP.
- 2023NEJM 2023;389:2446
Restrictive or liberal transfusion strategy in myocardial infarction and anemia (MINT)
Carson JL, Brooks MM, Hébert PC, et al.
For acute MI, a trigger near 8–10 is reasonable — do not be dogmatic about 7 in active ischemia.
- 2023NEJM 2023;388:1111
Right ventricular failure
Houston BA, Brittain EL, Tedford RJ
RV shock: do not intubate casually, do not drop the pressure, and do not flood an already high CVP.
- 2023NEJM 2023;389:1069
Semaglutide in patients with heart failure with preserved ejection fraction and obesity (STEP-HFpEF)
Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al.
Treat the obese HFpEF phenotype with GLP-1 RA in addition to SGLT2i and MRA — weight loss is a HF therapy.
- 2023NEJM 2023 / 2025;392:1987
Sotatercept for pulmonary arterial hypertension (STELLAR and outcome updates)
Hoeper MM, Badesch DB, Ghofrani HA, et al.
Sotatercept is add-on Group 1 PAH therapy — watch for erythrocytosis and bleeding from telangiectasias.
- 2022Circ 2022;145:e895
2022 AHA/ACC/HFSA guideline for the management of heart failure
Heidenreich PA, Bozkurt B, Aguilar D, et al.
HFrEF = four drug classes, started in hospital, titrated after discharge. HFpEF = SGLT2i + MRA + treat comorbidities.
- 2022NEJM 2022;387:1185
Acetazolamide in acute decompensated heart failure with volume overload (ADVOR)
Mullens W, Dauw J, Martens P, et al.
Add acetazolamide 500 mg daily to loops when congestion is not breaking — it is a proven natriuretic adjunct.
- 2022AJG 2022;117:1
ACG clinical guideline for the diagnosis and management of GERD
Katz PO, Dunbar KB, Schnoll-Sussman FH, et al.
No alarm features: 8-week PPI trial. Dysphagia, bleeding, weight loss, age ≥60 → scope first.
- 2022NEJM 2022;387:989
Aggressive or moderate fluid resuscitation in acute pancreatitis (WATERFALL)
de-Madaria E, Buxbaum JL, Maisonneuve P, et al.
Pancreatitis fluids: moderate LR, not 250–300 mL/h for everyone.
- 2022NEJM 2022;387:1089
Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction (DELIVER)
Solomon SD, McMurray JJV, Claggett B, et al.
Dapagliflozin helps HFmrEF, HFpEF, and HFimpEF — do not stop SGLT2i just because EF recovered.
- 2022JAMA 2022;328:280
Diagnosis and management of hyponatremia
Adrogué HJ, Tucker BM, Madias NE
Seizing hyponatremia gets 3% saline now. Chronic hyponatremia is a slow-correction disease — overcorrection is the iatrogenic disaster.
- 2022ERJ 2022 / 2023;61:2200879
ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension
Humbert M, Kovacs G, Hoeper MM, et al.
mPAP ≥20 is PH; PVR and PCWP tell you the group. Call the PH team before holding epoprostenol.
- 2022NEJM 2022;386:463
Fever of unknown origin
Haidar G, Singh N
FUO is a structured hunt, not a piperacillin-tazobactam infusion. Stop, reculture, image, and think Adult-onset Still, endocarditis, and occult abscess.
- 2022NEJM 2022;387:1351
Percutaneous revascularization for ischemic left ventricular dysfunction (REVIVED-BCIS2)
Perera D, Clayton T, O’Kane PD, et al.
Do not send stable ischemic CM for PCI solely to improve EF or survival — CABG still has a role in selected anatomy.
- 2022Lancet 2022;400:1938
Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF)
Mebazaa A, Davison B, Chioncel O, et al.
Do not wait months to uptitrate GDMT — start low-dose quadruple therapy in hospital and see the patient early after discharge.
- 2021AJG 2021;116:5
ACG guideline on upper GI and ulcer bleeding
Laine L, Barkun AN, Saltzman JR, et al.
UGIB: ABC, GBS, transfuse at 7, PPI, call GI. Forrest Ia–IIb need endoscopic therapy and high-dose PPI.
- 2021Chest 2021;160:e545
Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report
Stevens SM, Woller SC, Kreuziger LB, et al.
3 months for provoked VTE; forever if unprovoked and they can take a pill safely. Filters are not a treatment — they are a bridge.
- 2021CID 2021;73:e1029
Clostridioides difficile infection in adults: 2021 focused update (IDSA/SHEA)
Johnson S, Lavergne V, Skinner AM, et al.
CDI: fidaxomicin (or PO vanc). Stop the offending antibiotic. Never treat colonization or use test-of-cure.
- 2021Hepatology 2021;74:1014
Diagnosis, evaluation, and management of ascites, SBP and HRS (AASLD)
Biggins SW, Angeli P, Garcia-Tsao G, et al.
Tap every cirrhotic with ascites on arrival. SBP is a lab diagnosis, not a fever diagnosis.
- 2021NEJM 2021;385:1451
Empagliflozin in heart failure with a preserved ejection fraction (EMPEROR-Preserved)
Anker SD, Butler J, Filippatos G, et al.
SGLT2 inhibitors are the first drug class with a definitive outcome benefit in HFpEF — start them unless contraindicated.
- 2021KDIGO 2021
KDIGO 2021 clinical practice guideline for the management of glomerular diseases
KDIGO Glomerular Diseases Work Group
Nephrotic workup always includes PLA2R, SPEP/SFLC, HBV/HCV/HIV, A1c, and ANA — treatment is disease-specific.
- 2021Intensive Care Med 2021;47:1181
Surviving Sepsis Campaign: international guidelines for management of sepsis/septic shock 2021
Evans L, Rhodes A, Alhazzani W, et al.
Septic shock: cultures, 1-hour antibiotics, fluids, norepinephrine — source control is the actual cure.
- 2021NEJM 2021;384:818 / NEJM 2023;388
Terlipressin plus albumin for hepatorenal syndrome (CONFIRM) and HRS redefinition
Wong F, Pappas SC, Curry MP, et al.
HRS-AKI is a diagnosis of exclusion after albumin challenge. Terlipressin helps kidneys, can drown lungs — pick patients with lower ACLF.
- 2021Williams Hematology 2021
Williams Hematology — anemia and bone-marrow failure chapters
Kaushansky K, Lichtman MA, Prchal JT, et al.
Always start with the reticulocyte index before you order the entire anemia panel.
- 2020EHJ 2020;41:543
2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism
Konstantinides SV, Meyer G, Becattini C, et al.
PE treatment intensity follows hemodynamics and RV strain, not clot burden on the radiology report.
- 2020NEJM 2020;382:1599
Apixaban for the treatment of venous thromboembolism associated with cancer (Caravaggio)
Agnelli G, Becattini C, Meyer G, et al.
Cancer VTE: apixaban or LMWH. Prefer LMWH if active GI/GU luminal tumor.
- 2020Blood Adv 2020;4:4693
ASH 2020 guidelines for management of venous thromboembolism
Ortel TL, Neumann I, Ageno W, et al.
Low-risk PE can go home. Shocked PE gets lytics. Everyone else gets anticoagulation, not an IVC filter.
- 2020NEJM 2020;383:1413
Cardiovascular and renal outcomes with empagliflozin in heart failure (EMPEROR-Reduced)
Packer M, Anker SD, Butler J, et al.
Empagliflozin 10 mg daily is an evidence-based alternative to dapagliflozin in HFrEF, with added renal protection.
- 2020Lancet 2020;396:1895
Ferric carboxymaltose for iron deficiency at discharge after acute heart failure (AFFIRM-AHF)
Ponikowski P, Kirwan BA, Anker SD, et al.
Give IV iron before discharge after AHF if ferritin <100 or ferritin 100–299 + TSAT <20% and LVEF <50% — it cuts readmissions, not mortality.
- 2020Lancet 2018 / NEJM 2020 (ETHOS)
TRIBUTE and ETHOS triple-therapy COPD trials
Papi A et al. / Rabe KF et al.
Triple > dual for exacerbations; reassess ICS if pneumonia or eos <100.
- 2019NEJM 2019;381:1148
Anemia of inflammation
Weiss G, Ganz T, Goodnough LT
Treat the underlying disease and coexisting iron/B12/folate deficits; hepcidin physiology explains why oral iron often fails in AOCD.
- 2019NEJM 2019;380:539
Angiotensin–neprilysin inhibition in acute decompensated heart failure (PIONEER-HF)
Velazquez EJ, Morrow DA, DeVore AD, et al.
If the patient is off IV vasoactives with SBP ≳100, start ARNi before discharge rather than waiting for clinic.
- 2019NEJM 2019;380:711 / 380:720
Apixaban (AVERT) and rivaroxaban (CASSINI) to prevent VTE in ambulatory cancer patients
Carrier M et al. / Khorana AA et al.
Khorana ≥2 starting chemo: consider low-dose DOAC prophylaxis if bleed risk is acceptable.
- 2019NEJM 2019;381:111
C-reactive protein–guided antibiotic use for COPD exacerbations
Butler CC, Gillespie D, White P, et al.
Not every COPD flare needs antibiotics — CRP and sputum purulence help you choose.
- 2019NEJM 2019;381:1995
Dapagliflozin in patients with heart failure and reduced ejection fraction (DAPA-HF)
McMurray JJV, Solomon SD, Inzucchi SE, et al.
SGLT2 inhibitors are foundational HFrEF therapy regardless of diabetes — start dapagliflozin 10 mg daily unless eGFR is too low or a procedure is imminent.
- 2019AJRCCM 2019;200:e45 / AJRCCM 2025
Diagnosis and treatment of adults with community-acquired pneumonia (ATS/IDSA)
Metlay JP, Waterer GW, Long AC, et al.
No more HCAP. 5 days if clinically stable. MRSA nasal swab NPV ~98% to stop vanc.
- 2019NEJM 2019;381:2125
Diagnosis of pulmonary embolism with D-dimer adjusted to clinical probability (YEARS / YEARS-adapted)
van der Hulle T, Cheung WY, Kooij S, et al. / Kearon C, de Wit K, Parpia S, et al. (PEGeD)
Low Wells + D-dimer <1000 (or age-adjusted) = no CTPA. High pretest probability skips D-dimer and goes to imaging.
- 2019NEJM 2019;380:1997
Early neuromuscular blockade in moderate-severe ARDS (ROSE)
National Heart, Lung, and Blood Institute PETAL Clinical Trials Network
Do not paralyze every ARDS patient — use NM blockade for dyssynchrony or when Pplat/hypoxemia demand it.
- 2019NEJM 2019;380:1326
Full study report of andexanet alfa for bleeding associated with factor Xa inhibitors (ANNEXA-4)
Connolly SJ, Crowther M, Eikelboom JW, et al.
If andexanet is unavailable, give 4-factor PCC for life-threatening DOAC-Xa bleeding plus local measures.
- 2019Blood 2019;133:2465 / Pediatr Blood Cancer 2007
HLH-2004 diagnostic criteria and adult HLH management
La Rosée P, Horne A, Hines M, et al.
Ferritin in the thousands + fever + cytopenias is HLH until you prove it is not — calculate the H-score and hunt EBV/lymphoma.
- 2019NEJM 2019;381:945
Immune thrombocytopenia
Cooper N, Ghanima W
Do not transfuse platelets in ITP unless life-threatening bleed — they are consumed and can worsen counts.
- 2019NEJM 2019;381:1718
Nintedanib in progressive fibrosing interstitial lung diseases (INBUILD)
Flaherty KR, Wells AU, Cottin V, et al.
Progressive fibrotic ILD that is not IPF still deserves nintedanib if FVC is sliding.
- 2019NEJM 2019;381:647
Warm autoimmune hemolytic anemia
Brodsky RA
Warm AIHA: DAT IgG, steroids first, rituximab second. Cold AIHA is complement-only — skip steroids/splenectomy, use rituximab/sutimlimab.
- 2018NEJM 2018;378:829
Balanced crystalloids versus saline in critically ill adults (SMART)
Semler MW, Self WH, Wanderer JP, et al.
Default to lactated Ringer’s for large-volume resuscitation — saline is not the default ‘safe’ fluid.
- 2018NEJM 2018;378:819
Balanced crystalloids versus saline in noncritically ill adults (SALT-ED)
Self WH, Semler MW, Wanderer JP, et al.
Even on the floor, prefer LR over NS when giving liters of fluid.
- 2018NEJM 2018;378:2020 / 378:1865 / 378:1877
ICS-formoterol as reliever (Novel START, PRACTICAL, and related MART trials)
Beasley R, Holliday M, Reddel HK, et al. / Hardy J, et al.
Mild asthma still needs an inhaled steroid on board — as-needed ICS-formoterol is enough for many.
- 2018NEJM 2018;378:1671
Once-daily triple therapy vs dual in COPD (IMPACT)
Lipson DA, Barnhart F, Brealey N, et al.
Triple therapy cuts exacerbations in frequent exacerbators but raises pneumonia — use eos to decide who keeps ICS.
- 2018NEJM 2018;378:603
Outcomes after angiography with sodium bicarbonate and acetylcysteine (PRESERVE)
Weisbord SD, Gallagher M, Jneid H, et al.
Skip bicarb drips and NAC for contrast — volume with saline (or skip extra fluid if already overloaded) is enough.
- 2017NEJM 2017;377:431
Idarucizumab for dabigatran reversal (RE-VERSE AD)
Pollack CV, Reilly PA, van Ryn J, et al.
Life-threatening dabigatran bleed: idarucizumab 5 g. For Xa inhibitors, 4F-PCC is the practical reversal now that andexanet left the US market.
- 2017Lancet Haematol 2017;4:e524
Iron absorption from oral iron supplements given on consecutive versus alternate days
Stoffel NU, Cercamondi CI, Brittenham G, et al.
Prescribe ferrous sulfate 325 mg every other day — daily dosing is worse for absorption and GI side effects.
- 2017Cochrane 2004 / JAMA 2017;317:2177
Noninvasive ventilation for COPD respiratory acidosis and nocturnal NIPPV
Lightowler JV et al. / Murphy PB et al.
Acidotic COPD → BiPAP now. Persistent PaCO2 >53 after exacerbation → consider home NIV.
- 2017JACC 2017;69:871
Periprocedural management of anticoagulation
Doherty JU, Gluckman TJ, Hucker WJ, et al. (ACC expert consensus)
DOACs: hold, don’t bridge. Warfarin: bridge mechanical mitral valves and recent VTE, not garden-variety AF (BRIDGE).
- 2017NEJM 2017;377:2133
Restrictive or liberal red-cell transfusion for cardiac surgery (TRICS III)
Mazer CD, Whitlock RP, Fergusson DA, et al.
Cardiac surgery: restrictive trigger ~7.5 is acceptable. ACS may still warrant a higher individual threshold.
- 2017NEJM 2017;377:1319
Rivaroxaban with or without aspirin in stable cardiovascular disease (COMPASS)
Eikelboom JW, Connolly SJ, Bosch J, et al.
Very-low-dose rivaroxaban + ASA is vascular prevention, not VTE therapy — different dose, different indication.
- 2017NEJM 2017;377:1177
Thrombophilia testing and venous thrombosis
Connors JM
Most unprovoked VTE does not need a thrombophilia workup — it needs a conversation about indefinite anticoagulation.
- 2016NEJM 2016;375:1660
Hepatic encephalopathy
Wijdicks EFM
New AMS in cirrhosis: lactulose plus a hunt for bleed, SBP, and benzos — do not wait on an ammonia to treat.
- 2016CID 2016;63:e61
Management of adults with hospital-acquired and ventilator-associated pneumonia (IDSA/ATS)
Kalil AC, Metersky ML, Klompas M, et al.
HAP/VAP: cover MRSA/PsA when risk is real, treat 7 days, and do not add metronidazole for garden-variety aspiration.
- 2016Gut 2013 / NEJM 2016;375:1972
Revised Atlanta classification and pancreatitis reviews
Banks PA et al. / Forsmark CE, Vege SS, Wilcox CM
Pancreatitis: LR, eat when hungry, ERCP for cholangitis not for every gallstone pancreatitis, delay necrosectomy.
- 2015NEJM 2015;373:252
Heparin-induced thrombocytopenia
Greinacher A
4Ts ≥4: stop heparin now, start argatroban/fondaparinux/DOAC, do not wait for the ELISA. Never give platelets unless life-threatening bleed.
- 2015Circ 2015;132:1435
Infective endocarditis in adults: AHA scientific statement / IDSA-endorsed
Baddour LM, Wilson WR, Bayer AS, et al.
MSSA endocarditis: nafcillin/cefazolin, never settle for vancomycin if you can use a beta-lactam.
- 2015NEJM 2015;373:834
Initial use of ambrisentan plus tadalafil in pulmonary arterial hypertension (AMBITION)
Galiè N, Barberà JA, Frost AE, et al.
Newly diagnosed PAH that is not high-risk: start ERA + PDE5i together, not sequentially over months.
- 2015NEJM 2015;372:1832
Iron-deficiency anemia
Camaschella C
Ferritin <30 (or TSAT <16–20% with inflammation) = iron deficiency until proven otherwise — then find the leak.
- 2015CID 2015;61:e26 / CID 2023
Native vertebral osteomyelitis and diabetic foot osteomyelitis guidelines
Berbari EF et al. / IDSA 2023 updates
Stable osteomyelitis: hold the cefepime, get the bone biopsy.
- 2015NEJM 2015;373:823
Perioperative bridging anticoagulation in patients with atrial fibrillation (BRIDGE)
Douketis JD, Spyropoulos AC, Kaatz S, et al.
Do not bridge average-risk AF for procedures — bridging bleeds more than it protects. Still bridge most mechanical mitral valves.
- 2015NEJM 2015;373:60
Potassium homeostasis and hypokalemia / related NEJM potassium reviews
Palmer BF, Clegg DJ
ECG changes or K >6.5: calcium, shift, remove. iHD beats CRRT when you need potassium off now.
- 2015NEJM 2015;372:1619
Prednisolone or pentoxifylline for alcoholic hepatitis (STOPAH)
Thursz MR, Richardson P, Allison M, et al.
Severe AH (MDF ≥32 or MELD ≥20): consider prednisolone 40 mg × 7 days, stop if Lille ≥0.45. Nutrition and alcohol cessation dominate long-term survival.
- 2014NEJM 2014;371:993
Angiotensin–neprilysin inhibition versus enalapril in heart failure (PARADIGM-HF)
McMurray JJV, Packer M, Desai AS, et al.
ARNi beats ACE inhibitor for death and HF hospitalization in HFrEF — prefer sacubitril/valsartan when it can be afforded and tolerated.
- 2014NEJM 2014;370:1402
Fibrinolysis for patients with intermediate-risk pulmonary embolism (PEITHO)
Meyer G, Vicaut E, Danays T, et al.
Save systemic thrombolysis for high-risk/shocked PE; for intermediate-high, anticoagulate, watch, and consider catheter-directed therapy selectively.
- 2014NEJM 2014;370:2071 / 370:2083
Nintedanib (INPULSIS) and pirfenidone (ASCEND) in idiopathic pulmonary fibrosis
Richeldi L et al. / King TE et al.
IPF: start an antifibrotic and refer for transplant at diagnosis. Steroids are for exacerbations, not chronic IPF.
- 2014CID 2014;59:e10
Practice guidelines for the diagnosis and management of skin and soft tissue infections
Stevens DL, Bisno AL, Chambers HF, et al.
Pain out of proportion, crepitus, or rapid spread = call surgery before the second antibiotic dose.
- 2014NEJM 2014;370:1383 / Circ 2015;131:34
Spironolactone for heart failure with preserved ejection fraction (TOPCAT)
Pitt B, Pfeffer MA, Assmann SF, et al.
Spironolactone is reasonable in HFpEF with careful K/Cr monitoring — the Americas TOPCAT signal is the one that matters.
- 2014NEJM 2014;371:654
Syndromes of thrombotic microangiopathy
George JN, Nester CM
MAHA + thrombocytopenia: start PLEX empirically if TTP is possible — ADAMTS13 can come back later.
- 2013NEJM 2013;369:2093
Edoxaban versus warfarin in patients with atrial fibrillation (ENGAGE AF-TIMI 48)
Giugliano RP, Ruff CT, Braunwald E, et al.
Skip edoxaban when CrCl >95; otherwise 60 mg daily, 30 mg if CrCl 15–50 or weight ≤60 kg.
- 2013JAMA 2013;310:2533
Low-dose dopamine or nesiritide in acute heart failure with renal dysfunction (ROSE-AHF)
Chen HH, Anstrom KJ, Givertz MM, et al.
Do not start renal-dose dopamine to ‘protect the kidneys’ in decompensated HF.
- 2013NEJM 2013;369:799
Oral apixaban for the treatment of acute venous thromboembolism (AMPLIFY)
Agnelli G, Buller HR, Cohen A, et al.
Apixaban VTE: 10/10 for 7 days, then 5/5; after 6 months consider 2.5 mg BID if extended.
- 2013NEJM 2013;368:2159
Prone positioning in severe ARDS (PROSEVA)
Guérin C, Reignier J, Richard JC, et al.
Severe ARDS (P/F <150): prone early, 16+ hours, not as a last-ditch salvage only.
- 2013JAMA 2013;309:2223
Short-term vs conventional glucocorticoid therapy in COPD exacerbations (REDUCE)
Leuppi JD, Schuetz P, Bingisser R, et al.
COPD exacerbation: prednisone 40 mg × 5 days, no taper. Longer courses add harm, not benefit.
- 2013NEJM 2013;368:2169
Terminal complement inhibitor eculizumab in atypical hemolytic–uremic syndrome
Legendre CM, Licht C, Muus P, et al.
Once TTP is excluded, complement-mediated HUS gets eculizumab (or ravulizumab) — vaccinate for meningococcus.
- 2013NEJM 2013;368:11
Transfusion strategies for acute upper gastrointestinal bleeding
Villanueva C, Colomo A, Bosch A, et al.
Variceal and ulcer bleeds: restrictive transfusion saves lives. Overtransfusion raises portal pressure.
- 2013NEJM 2013;368:1210
Treatment of anemia with darbepoetin alfa in systolic heart failure (RED-HF)
Swedberg K, Young JB, Anand IS, et al.
Do not use ESA for the anemia of heart failure — replete iron instead (FAIR-HF / AFFIRM-AHF).
- 2012KDIGO 2012
KDIGO clinical practice guideline for acute kidney injury
KDIGO AKI Work Group
Stage AKI, assume GFR <10 if Cr rises >1/day, and dialyze for AEIOU — not for a pretty creatinine.
- 2012JAMA 2012;307:2526
The Berlin definition of ARDS
ARDS Definition Task Force (Ranieri VM, Rubenfeld GD, et al.)
Berlin: timing, bilateral opacities, not just heart failure, PEEP ≥5, then grade by P/F.
- 2012NEJM 2012;367:2296
Ultrafiltration in decompensated heart failure with cardiorenal syndrome (CARRESS-HF)
Bart BA, Goldsmith SR, Lee KL, et al.
Do not jump to ultrafiltration for cardiorenal congestion — escalate loops ± thiazide first.
- 2011NEJM 2011;365:981
Apixaban versus warfarin in patients with atrial fibrillation (ARISTOTLE)
Granger CB, Alexander JH, McMurray JJV, et al.
Apixaban is the go-to DOAC for older, lower-weight, or CKD patients — check the 2-of-3 dose-reduction rule.
- 2011CID 2011;52:e56
Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer
Freifeld AG, Bow EJ, Sepkowitz KA, et al.
Febrile neutropenia is a 60-minute emergency. Cefepime first; vanc only with a reason.
- 2011NEJM 2011;364:1607
Coronary-artery bypass surgery in patients with left ventricular dysfunction (STICH)
Velazquez EJ, Lee KL, Deja MA, et al.
Surgical revascularization can still help ischemic CM with suitable anatomy; PCI is not a substitute based on REVIVED.
- 2011NEJM 2011;364:11
Eplerenone in patients with systolic heart failure and mild symptoms (EMPHASIS-HF)
Zannad F, McMurray JJV, Krum H, et al.
Eplerenone is the cleaner MRA when gynecomastia or androgenic side effects limit spironolactone.
- 2011CID 2011;52:e103
International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women
Gupta K, Hooton TM, Naber KG, et al.
No symptoms, no antibiotics — pyuria is not a treatment indication. Nitrofurantoin for simple cystitis.
- 2011NEJM 2011;365:883
Rivaroxaban versus warfarin in nonvalvular atrial fibrillation (ROCKET AF)
Patel MR, Mahaffey KW, Garg J, et al.
Rivaroxaban for AF is once daily with food; use 15 mg daily if CrCl 15–50.
- 2010CID 2010;50:133
Diagnosis and management of complicated intra-abdominal infection in adults and children (IDSA/SIS)
Solomkin JS, Mazuski JE, Bradley JS, et al.
Biliary and intra-abdominal infection: source control first (ERCP, drain, operate), then 4–7 days of enteric + anaerobic coverage — not weeks of vanc.
- 2010BMJ 2010;341:c5462
Effect of high flow oxygen on mortality in COPD: a randomized trial
Austin MA, Wills KE, Blizzard L, Walters EH, Wood-Baker R
COPD exacerbation target SpO2 88–92%. Oxygen is a drug with a dose.
- 2010Ann Intern Med 2010;152:590
Noninvasive ventilation in acute cardiogenic pulmonary edema
Weng CL, Zhao YT, Liu QH, et al. (meta-analysis)
Flash pulmonary edema: sit them up, CPAP/BiPAP, nitro, loops — not immediate RSI unless they are crashing.
- 2010NEJM 2010;363:2499
Oral rivaroxaban for symptomatic venous thromboembolism (EINSTEIN)
EINSTEIN Investigators
Rivaroxaban VTE load is 15 mg BID for 21 days, then 20 mg daily with food — no heparin bridge needed.
- 2009NEJM 2009;361:1139
Dabigatran versus warfarin in patients with atrial fibrillation (RE-LY)
Connolly SJ, Ezekowitz MD, Yusuf S, et al.
Dabigatran 150 mg BID is the stroke-prevention dose; drop to 75 mg BID only for CrCl 15–30 (US labeling).
- 2009NEJM 2009;361:2342
Dabigatran versus warfarin in the treatment of acute venous thromboembolism (RE-COVER)
Schulman S, Kearon C, Kakkar AK, et al.
Dabigatran for VTE requires 5 days of heparin first — do not start it on day 0 like apixaban.
- 2009NEJM 2009;361:2436
Ferric carboxymaltose in patients with heart failure and iron deficiency (FAIR-HF)
Anker SD, Comin Colet J, Filippatos G, et al.
IV iron improves symptoms, functional class, and 6MWT in HFrEF with iron deficiency — treat iron deficiency even if hemoglobin is normal.
- 2009NEJM 2009;361:11
M-type phospholipase A2 receptor as target antigen in idiopathic membranous nephropathy
Beck LH, Bonegio RGB, Lambeau G, et al.
PLA2R-positive membranous is primary until proven otherwise — titer is a biomarker, not just a diagnostic.
- 2009Gastroenterology 2009;137:856 / NEJM reviews
N-acetylcysteine in non-acetaminophen acute liver failure
Lee WM, Hynan LS, Rossaro L, et al.
Give NAC in ALF even if the APAP level is negative and coma grade is low-to-moderate — cheap, safe, sometimes disease-modifying.
- 2007Chest 2007;132:1741
Oral vs intravenous corticosteroids in COPD exacerbations
de Jong YP, Uil SM, Grotjohan HP, et al.
If they can take a pill, PO steroids = IV steroids for COPD flares.
- 2006NEJM 2006;354:2564
Comparison of two fluid-management strategies in ARDS (FACTT)
Wiedemann HP, Wheeler AP, Bernard GR, et al. (NHLBI ARDS Network)
After shock is resolved, run ARDS dry-ish — conservative fluids get people off the ventilator faster.
- 2006NEJM 2006;354:2317
Effectiveness of managing suspected pulmonary embolism using an algorithm including clinical probability, D-dimer, and CT (Christopher)
van Belle A, Büller HR, Huisman MV, et al.
Negative CTPA in a structured algorithm is enough to withhold anticoagulation.
- 2006NEJM 2010;362:1169 / Chest 2006;129:15
LABA without ICS and asthma death (SMART and related analyses)
Nelson HS, Weiss ST, Bleecker ER, et al.
LABA monotherapy in asthma kills — always pair with ICS. COPD is different.
- 2004Cochrane Review 2004
Non-invasive positive pressure ventilation for COPD exacerbations
Lightowler JV, Wedzicha JA, Elliott MW, Ram FSF
pH 7.25–7.35 COPD: BiPAP, not an ABG every 20 minutes while they tire out.
- 2004CID 2004;39:1267
Practice guidelines for the management of bacterial meningitis
Tunkel AR, Hartman BJ, Kaplan SL, et al.
Age ≥50 meningitis: vanc + CTX + ampicillin. Steroids if pneumococcus likely. Abx first if LP will wait.
- 2001NEJM 2001;344:1651
Effect of carvedilol on survival in severe chronic heart failure (COPERNICUS)
Packer M, Coats AJS, Fowler MB, et al.
Evidence-based beta-blockers (carvedilol, metoprolol succinate, bisoprolol) are disease-modifying — do not start in cold/wet shock.
- 2000Lancet 2000;356:1318
A risk score to predict need for treatment of upper-GI haemorrhage (Glasgow-Blatchford)
Blatchford O, Murray WR, Blatchford M
GBS 0–1: consider discharge. Anyone with syncope, tachycardia, or anemia stays.
- 2000NEJM 2000;342:1301
Ventilation with lower tidal volumes as compared with traditional tidal volumes for ARDS (ARMA)
Acute Respiratory Distress Syndrome Network
ARDS: VT 6 mL/kg predicted body weight, Pplat ≤30. Never use actual body weight for VT.
- 1999NEJM 1999;340:409
A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care (TRICC)
Hébert PC, Wells G, Blajchman MA, et al.
Default RBC trigger is Hb <7 in stable patients — this trial started the restrictive era.
- 1999NEJM 1999;341:625
Early revascularization in acute myocardial infarction complicated by cardiogenic shock (SHOCK)
Hochman JS, Sleeper LA, Webb JG, et al.
AMI + shock = activate the cath lab. Do not delay revascularization for a trial of pressors on the floor.
- 1999Lancet 1999;353:2001
Effect of metoprolol CR/XL in chronic heart failure (MERIT-HF)
MERIT-HF Study Group
Use metoprolol succinate, not tartrate, for HFrEF mortality benefit; target 200 mg daily.
- 1999NEJM 2004;350:1646
Intravenous albumin in patients with cirrhosis and spontaneous bacterial peritonitis (SORT)
Sort P, Navasa M, Arroyo V, et al.
SBP + Cr >1 or bili >4: give albumin on day 1 and 3 — it is a mortality intervention.
- 1999NEJM 1999;341:709
The effect of spironolactone on morbidity and mortality in patients with severe heart failure (RALES)
Pitt B, Zannad F, Remme WJ, et al.
Mineralocorticoid-receptor antagonists save lives in HFrEF — start low-dose spironolactone and check K/Cr within 72 hours.
- 1997NEJM 1997;337:1870
A randomized controlled trial comparing 10k vs 20k platelet transfusion threshold in AML
Rebulla P, Finazzi G, Marangoni F, et al.
Prophylactic platelets at <10k; raise to <50k for major bleed/invasive procedures.
- 1990JAMA 1990;263:2753
Value of the ventilation/perfusion scan in acute pulmonary embolism (PIOPED)
PIOPED Investigators
V/Q is useful only if the CXR is clean — otherwise you get nondiagnostic scans.
- 1989Gastroenterology 1989;97:439
King’s College criteria for liver transplantation in fulminant hepatic failure
O’Grady JG, Alexander GJ, Hayllar KM, Williams R
ALF + meeting King’s College = call transplant now, not after the next set of labs.