Of all the medications available to physicians worldwide, antibiotics play an essential role in inpatient and outpatient settings. Discovered in the early nineteenth century by Alexander Fleming, penicillin was the first antibiotic isolated from a mold. Dr. Gerhard Domagk developed synthetic sulfa drugs by altering the red dye used in chemical industries. Since then, multiple antibiotic classes have been discovered with varying antimicrobial effects enabling their use empirically or in specific clinical scenarios. Antibiotics with different mechanisms of action could be either bactericidal or bacteriostatic. However, no clinical significance has been observed between cidal and static antibiotics in multiple trials. Their presence has led to safer deep invasive surgeries, advanced chemotherapy in cancer, and organ transplantation. Indiscriminate usage of antibiotics has resulted in severe hospital-acquired infections, including nosocomial pneumonia, Clostridioides difficile infection, multidrug-resistant invasive bacterial infections, allergic reactions, and other significant side effects. Antibiotic stewardship is an essential process in the modern era to advocate judicial use of antibiotics for an appropriate duration. They play a vital role in medical and surgical intensive care units to address the various complications seen in these patients. Antibiotics are crucial in severe acute infections to improve overall mortality and morbidity.
Part of the book: Infections and Sepsis Development
Pulmonary embolism is an acute emergency due to the occlusion of the pulmonary arteries by a venous blood clot. The pathophysiology of pulmonary embolism follows Virchow\'s triad, which encompasses stasis in veins, increased coagulation, and vessel wall trauma. Pregnancy, major trauma or surgery, prolonged immobilization, obesity, medication, and inherited risks are important risks. It is an essential rule-out diagnosis in chest pain and dyspnea patients in the emergency room. It is also responsible for significant mortality if not diagnosed and treated promptly. Physicians utilize multiple algorithmic scores and calculators to supplement diagnosis along with a high degree of clinical suspicion at initial presentation. Clinical diagnosis involves utilizing multiple modalities, including D-dimer, troponin, arterial blood gas analysis, electrocardiogram, bedside echocardiogram, and imaging modalities such as venous duplex, chest computed tomography, ventilation-perfusion scans, and pulmonary angiogram. Some imaging modalities carry the risk of radiation and being invasive. The treatment can itself be short-term or lifelong based on the causative factor. Anticoagulants used in the therapy can itself cause devastating complications if not monitored appropriately. Despite adequate treatment, some of these patients progress to chronic disease resulting in secondary pulmonary hypertension.
Part of the book: Pulmonary Embolism