Latest Updates

Septic Shock

Allison Dalton, MD , Mark Nunnally, MD, FCCM
    • Enhanced awareness is driving diagnosis and therapy sooner. We are more accurate and faster at diagnosing sepsis, which improves outcomes.
    • Prompt aggressive resuscitation is important for outcomes. The recipe for resuscitation does not matter as much as getting started promptly and then slowing fluid therapies in response to physiologic end points.
    • Sepsis changes immune, endocrine, and neurologic function, leading to immunosuppression and metabolic changes. Depending on severity and duration, suppression and changes produce long-term disabilities or death.

Diagnosis and Management of Barrett Esophagus 

Arianna Barbetta, MD, Daniela Molena, MD, Francisco Schlottmann, MD
    • The diagnostic accuracy of BE increases when the Seattle protocol is applied.
    • Chromoendoscopy, narrow-band imaging, autofluorescence imaging, and confocal laser endomicroscopy can increase lesion identification and decrease the number of biopsies needed for BE surveillance.
    • Surveillance is encouraged to monitor for progression and deliver early treatment. 
    • In the presence of high-grade dysplasia or multifocal or recurrent low-grade dysplasia, endoscopic treatment should be preferred over surveillance.
    • Treatment of dysplastic BE can reduce the risk of progression to esophageal adenocarcinoma. 

Septic Shock

Allison Dalton, MD , Mark Nunnally, MD, FCCM
    • Enhanced awareness is driving diagnosis and therapy sooner. We are more accurate and faster at diagnosing sepsis, which improves outcomes.
    • Prompt aggressive resuscitation is important for outcomes. The recipe for resuscitation does not matter as much as getting started promptly and then slowing fluid therapies in response to physiologic end points.
    • Sepsis changes immune, endocrine, and neurologic function, leading to immunosuppression and metabolic changes. Depending on severity and duration, suppression and changes produce long-term disabilities or death.

Feeding and Eating Disorders

Phillip S Mehler, MD, Patricia Westmoreland, MD
    • With the DSM-5, rumination and pica are now placed in the same chapter as bulimia nervosa and anorexia nervosa.
    • In the DSM-5, diagnoses were modified and expanded to better describe patient diversity, especially with respect to age.
    • According to a recent study, implementation of the DSM-5 criteria may dramatically reduce residual eating disorder diagnoses within clinical settings.

Anesthesia for Airway Endoscopy and Micro-Laryngeal Surgery

Paul H. Alfille, MD, Vicki E. Modest, MD
    • Airway endoscopy and micro-laryngeal surgeries require thorough preoperative patient evaluation and pre-procedural time-out with the surgeon to clarify interventional intent and establishment of airway management plans.
    • Patients for tracheal and peri-glottic surgeries often present with critically compromised airways. Location, type and extent of pathology will determine the safest induction and airway access plan. Skill with adult inhalational induction and fiberoptic airway management is essential.
    • Airway endoscopy and micro-laryngeal surgeries present intraoperative ventilation challenges, often requiring non-conventional ventilation approaches including jet ventilation through small-bore catheters. Expertise in management is required. 
    • Airway surgeries are at the highest risk of airway fire whenever an ignition source such as electrocautery or laser are used. A fire plan should be agreed upon prior to starting and should follow ASA guidelines.

Sexual Dysfunctions

Atef Bakhoum, MD, PhD, Waguih William IsHak, MD, FAPA, Lancer Naghdechi, DO, MS
    • Updated treatments for male hypoactive sexual desire disorder
    • Enhanced understanding of the risk factors for erectile disorders
    • Enhanced understanding of female sexual interest/arousal disorder and female orgasmic disorder

Overview of Posttraumatic Stress Disorder

Dana Downs, MA, MSW, Carol North, MD, MPE
    • 2016 Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: systemic review and meta-analyses to determine first-line treatments
    • 2012 Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder

Overview of Posttraumatic Stress Disorder

Dana Downs, MA, MSW, Carol North, MD, MPE
    • 2016 Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: systemic review and meta-analyses to determine first-line treatments
    • 2012 Review of VA/DOD Clinical Practice Guideline on management of acute stress and interventions to prevent posttraumatic stress disorder
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