Session 1:

In the given patient scenario, what labs/imaging would you order if you suspect UTI/hydronephrosis?

• Labs:
  • UA
  • Urine Culture
• Imaging:
  • Renal Ultrasound

How would you treat viral pneumonia?

All viral pneumonia patients must receive supportive care with oxygen, rest, antipyretics, analgesics, nutrition, and close observation. Older adults and people with chronic health conditions may need to stay in the hospital for extra care and to avoid dehydration. They may also be given an antiviral medication, which may help them to recover more quickly. If respiratory failure is present or impending, mechanical ventilation may be needed.

Session 2:

Research Xarelto and is it a good choice for PE and rate of complications? Is Xarelto a good choice for DVT ppx, should patient be placed on additional anticoagulants if admitted to hospital?

Rivaroxaban (Xarelto) is an anticoagulant that selectively blocks active site of factor Xa, inhibiting blood coagulation (factor Xa inhibitor). It is used to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation and in the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE).

According to UpToDate, oral factor Xa (rivaroxaban, apixaban, edoxaban) or direct thrombin inhibitors (dabigatran) are attractive candidates as initial oral anticoagulants in patients with acute VTE due to their quick onset of action (peak efficacy one to four hours after ingestion). Rivaroxaban and apixaban were evaluated as anticoagulants without prior administration of heparin (ie, monotherapy); as such they may be used as the sole initial anticoagulant. Rivaroxaban demonstrated similar efficacy to conventional therapy (heparin followed by warfarin) for the treatment of acute VTE in a large, prospective, randomized controlled trial. According to a NEJM article, a fixed-dose regimen of rivaroxaban alone was noninferior to standard therapy for the initial and long-term treatment of pulmonary embolism and had a potentially improved benefit–risk profile.

https://www.nejm.org/doi/full/10.1056/NEJMoa1113572?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

https://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/deep-venous-thrombosis-dvt-prevention