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41. Ketamine Procedural Sedation for Children in EDs

as ASA grade. This assessment should be formally documented. 8. Written consent should be obtained from the parents and young person if appropriate and written patient / parent information provided. 9. Monitoring during the procedure should include respiration, heart rate, oxygen saturation, three lead ECG, capnography, blood pressure and degree of dissociative sedation. 10. After the procedure the child should recover in a quiet, observed and monitored area under the continuous observation (...) as ASA grade. Obesity is an independent risk factor for procedural sedation [7]. This assessment should be formally documented. Documentation of procedural sedation is fundamental to ensuring safe and auditable practice in this area as well as monitoring the standard of care provided. Appendix 1 contains an example of a pro-forma template developed for use as a checklist, for formal recording, for monitoring and for the purposes of audit. Clinical Incident or event reporting during procedural

2020 Royal College of Emergency Medicine

42. Covid-19: Management of trauma and orthopaedic patients

Discharges Phase Prepare to respond Stop routines Prioritise Urgent Major Incident Trauma Operating Normal Increase day-case Maximise day-case Increase non-op Further increase non-op Consultant Surgeon Trauma Coordinator Early surgery to decrease LoS (using elective capacity) – No pre-op delays Elective Operating Normal except no Urgent and cancer only All elective surgery stops vulnerable patients e.g. ASA 1 only Fracture Clinic Normal new patient Increase use of splints All ED injuries triaged Start

2020 Covid-19 Ad hoc guidelines

43. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic Full Text available with Trip Pro

coronary events. is caused by a novel betacoronavirus officially named by the as . Coronaviruses are enveloped, single-stranded ribonucleic acid ( ) viruses with surface projections that correspond to surface spike proteins. 17 The natural reservoir of seems to be the chrysanthemum bat, 18 but the intermediate host remains unclear. is highly virulent and the transmission capacity is greater than the previous virus (outbreak in 2003), with high abundance in infected people (up to a billion copies/mL (...) inefficiently target virally infected cells. 4. Strategies for Diagnosing SARS-CoV-2 Key points Diagnosis of COVID-19 relies on a combination of epidemiological criteria (contact within incubation period), presence of clinical symptoms as well as laboratory testing (nucleic acid amplification tests) and clinical imaging based tests; Antibody and antigen based enzyme-linked immunosorbent assay ( ) tests are under development and are not yet fully validated; Widespread testing proves efficient

2020 European Society of Cardiology

44. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children

for KD; it is effective in reducing the risk of coronary artery disease when administered within 10 days of the onset of fever. In addition to IVIG, acetylsalicylic acid, glucocorticoids and anti-TNF monoclonal antibodies have been used to combat the inflammation [26]. Rapid diagnosis of KD and treatment with IVIG prevent coronary artery abnormalities (CAA). Without timely treatment, CAAs, and in particular aneurysms, could occur in up to 25% of children with KD [26,27]. Some children present

2020 ICM Anaesthesia COVID-19

45. Coronavirus (COVID-19) infection and pregnancy

stop-smoking support on an opt-out basis. • Women should continue to be encouraged to take folic acid and vitamin D supplements as per standard recommendations. • Pregnant women will continue to need at least as much support, advice, care and guidance in relation to pregnancy, childbirth and early parenthood as before the pandemic, especially women living with adversity including poverty, homelessness, substance misuse, being an asylum seeker, experiencing domestic abuse and mental health problems

2020 Royal College of Obstetricians and Gynaecologists

46. Child and Adolescent Asthma Guidelines

) - Breathlessness - Chest tightness - Cough • Particularly if: - Typically worse at night or in the early morning - Provoked by exercise, cold air, allergen exposure, irritants, viral infections, stress and aspirin - Recurrent or seasonal • Personal history of atopic disorder or family history of asthma • Widespread wheeze heard on chest auscultation • Otherwise unexplained expiratory airflow obstruction on spirometry • Otherwise unexplained blood eosinophilia or raised exhaled nitric oxide • Bronchial hyper

2020 Asthma and Respiratory Foundation NZ

47. Paediatric inflammatory multisystem syndrome temporally associated with COVID-19

group, which includes IVIG at 2 g/kg [ ] , to a maximum of 70 g/day (administered in accordance with institutional policy) and acetylsalicylic acid (ASA dosing per institutional policy). If not already ordered, consider adding ferritin, troponin, and NT-proBNP (when available) to KD evaluation, due to risk for cardiac dysfunction and MAS in complete/incomplete KD cases during the COVID-19 pandemic [ ] [ ] . An ECG and echocardiogram should be performed upon admission and repeated as indicated

2020 Canadian Paediatric Society

48. Coronavirus (COVID-19) infection and pregnancy

to take folic acid and vitamin D supplements as per national recommendations. • If women or their families express concerns about their mental health or ‘red flag’ symptoms such as suicidal thoughts or sudden mood changes they should be supported to access urgent care by healthcare providers signposting or referring appropriately. 11 24.7.20 2.3: Amended advice: • Visitors to isolation rooms or ward cohort bays should be kept to a minimum and follow local hospital visitor policies. 11 24.7.20 4.1 (...) testing of pregnant women has been paused during this period. o Midwives and doctors should still ask about, and document, smoking status at booking and at 36 weeks, provide brief advice and refer women who smoke to specialist stop-smoking support on an opt-out basis. • It is recommended that women should continue to take folic acid and vitamin D supplements as per national recommendations. • Pregnant women will continue to need at least as much support, advice, care and guidance in relation

2020 Royal College of Obstetricians and Gynaecologists

49. Dual vs single antiplatelet therapy Full Text available with Trip Pro

, Auxiliadora Fraiz , physiotherapist, nurse , Jillian Siemieniuk , nurse , Awah Cletus Fobuzi , patient and carer partner , Neelima Katragunta , vascular surgeon , Bram Rochwerg , methods co-chair, critical care clinician triggered by a randomised controlled trial published in the New England Journal of Medicine in August 2018. This trial and the linked review found that dual antiplatelet therapy (DAPT) with clopidogrel and aspirin (acetylsalicylic acid) during the first 21 days after the index event (...) December 2018) Cite this as: BMJ 2018;363:k5130 Recommendation 1: Dual vs single antiplatelet therapy or or Dual antiplatelet therapy Single agent therapy Aspirin and clopidogrel All identified trials compared with aspirin alone Patients that have experienced: High risk transient ischaemic attack (TIA) Minor ischaemic stroke Interventions compared Recommendation Population ASA CLOP + ASA A score of 3 or less on the National Institutes of Health Stroke Scale (NIHSS), and no persistent disabling

2018 BMJ Rapid Recommendations

53. Esophageal Adenocarcinoma

to all-cause mortality, esophageal adenocarcinoma or high-grade dysplasia for Barrett esophagus treated with combination high-dose proton pump inhibitors and acetylsalicylic acid. However, this RCT did not meet our review inclusion criteria as it is yet to be included in a systematic review. Newer forms of surgical treatment (e.g., combined endoscopic mucosal resection and radiofrequency ablation, endoscopic submucosal dissection) also need to be assessed. Conclusion The evidence reviewed (...) the Cytosponge-TFF3 test with usual care to facilitate the diagnosis of oesophageal pre-cancer in primary care patients with chronic acid reflux . Moinova HR , LaFramboise T , Lutterbaugh JD , et al . Identifying DNA methylation biomarkers for non-endoscopic detection of Barrett’s esophagus . Jankowski JAZ , de Caestecker J , Love SB , et al . Esomeprazole and aspirin in Barrett’s oesophagus (AspECT): a randomised factorial trial . In this issue Vol. 192 , Issue 27 6 Jul 2020 Article extras Podcast Article

2020 Canadian Task Force on Preventive Health Care

54. Spondyloarthritis in over 16s: diagnosis and management

Group (ESSG) axial spondyloarthritis criteria: Assessment of Spondyloarthritis International Society (ASAS; axial) Berlin Rome modified New York peripheral spondyloarthritis criteria: ASAS (peripheral) Classification of Psoriatic Arthritis (CASPAR) French Society of Rheumatology (reactive arthritis). 1.2.2 Do not rule out a diagnosis of spondyloarthritis solely on the basis of a negative HLA-B27 result. 1.2.3 Do not rule out a diagnosis of spondyloarthritis if a person's C-reactive protein (CRP (...) is not fully mature, request unenhanced MRI using an inflammatory back pain protocol. Subsequent in Subsequent inv vestigation using MRI estigation using MRI 1.2.7 Radiologists receiving a request for an inflammatory back pain MRI should perform short T1 inversion recovery (STIR) and T1 weighted sequences of the whole spine (sagittal view), and sacroiliac joints (coronal oblique view). 1.2.8 Use the ASAS/Outcome Measures in Rheumatology (OMERACT) MRI criteria to interpret the MRI as follows: If the MRI

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

55. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

tomography-based fractional flow reserve GEMINI- ACS A Study to Compare the Safety of Rivaroxaban Versus Acetylsalicylic Acid in Addition to Either Clopidogrel or Ticagrelor Therapy in Participants With Acute Coronary Syndrome GFR Glomerular filtration rate GLS Global longitudinal strain GOSPEL Global secondary prevention strategies to limit event recurrence after myocardial infarction HbA1c Glycated haemoglobin HF Heart failure ICA Invasive coronary angiography IMR Index of microcirculatory resistance (...) antithrombotic therapy in combination with aspirin 75-100 mg daily in alphabetical order in patients who have a high or moderate risk of ischaemic events, and do not have a high bleeding risk. 34 Table 10 Blood pressure thresholds for definition of hypertension with different types of blood pressure measurement 44 Table 11 Potential treatment options for refractory angina and summary of trial data 47 List of figures Figure 1 Schematic illustration of the natural history of chronic coronary syndromes 7 Figure

2019 European Society of Cardiology

56. Diagnosis and Management of Acute Pulmonary Embolism Full Text available with Trip Pro

weeks post-partum 38 Figure 8 Follow-up strategy and diagnostic workup for long-term sequelae of pulmonary embolism 44 Abbreviations and acronyms AcT Right ventricular outflow Doppler acceleration time AFE Amniotic fluid embolism ALT Alanine aminotransferase AMPLIFY Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-line Therapy ASPIRE Aspirin to Prevent Recurrent Venous Thromboembolism trial AV Arteriovenous b.i.d Bis in die (twice a day) BNP B-type (...) Plasminogen Activator for Occluded Coronary Arteries HAS-BLED Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly HERDOO2 Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30 kg/m 2 ; or Older age, ≥65 years H-FABP Heart-type fatty acid-binding protein HIV Human immunodeficiency virus HR Hazard ratio INR International

2019 European Society of Cardiology

57. Management of Dyslipidaemias Full Text available with Trip Pro

lipoprotein cholesterol levels 25 7.4 Lifestyle recommendations to improve the plasma lipid profile 25 7.4.1 Body weight and physical activity 25 7.4.2 Dietary fat 25 7.4.3 Dietary carbohydrate and fibre 26 7.4.4 Alcohol 26 7.4.5 Smoking 26 7.5 Dietary supplements and functional foods for the treatment of dyslipidaemias 26 7.5.1 Phytosterols 26 7.5.2 Monacolin and red yeast rice 26 7.5.3 Dietary fibre 27 7.5.4 Soy 27 7.5.5 Policosanol and berberine 27 7.5.6 n-3 unsaturated fatty acids 27 8 Drugs (...) diabetes mellitus 29 Increased risk of haemorrhagic stroke 29 Adverse effects on kidney function 29 Interactions 29 8.2 Cholesterol absorption inhibitors 30 8.2.1 Mechanism of action 30 8.2.2 Effects on lipids 30 8.2.3 Effect on cardiovascular morbidity and mortality 30 8.2.4 Adverse effects and interactions 30 8.3 Bile acid sequestrants 30 8.3.1 Mechanism of action 30 8.3.2 Effects on lipids 30 8.3.3 Effect on cardiovascular morbidity and mortality 30 8.3.4 Adverse effects

2019 European Society of Cardiology

58. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD Full Text available with Trip Pro

Management of blood pressure lowering 20 Effects of lifestyle intervention and weight loss 20 Pharmacological treatments 20 Blood pressure changes with glucose-lowering treatments 20 6.4 Lipids 21 6.4.1 Lipid-lowering agents 21 Statins 21 Ezetimibe 22 Proprotein convertase subtilisin/kexin type 22 Fibrates 22 6.5 Platelets 23 6.5.1 Aspirin 23 Primary prevention 24 Secondary prevention 24 6.6 Multifactorial approaches 24 6.6.1 (...) OGTT Oral glucose tolerance test ORIGIN Outcome Reduction With Initial Glargine Intervention PAD Peripheral arterial disease PCI Percutaneous coronary intervention PEGASUS- TIMI 54 Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin−Thrombolysis In Myocardial Infarction 54 PCSK9 Proprotein convertase subtilisin/kexin type 9 PIONEER 6 A Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects

2019 European Society of Cardiology

59. Management of Poisoning

to nontoxic levels (pg 76). Grade D, Level 4 Urinary pH manipulation D Urine alkalinisation increases the urine elimination of salicylate, chlorpropamide, 2,4-dichlorophenoxyacetic acid (herbicide), di? unisal, ? uoride, mecoprop (herbicide), methotrexate and phenobarbital. High urine ? ow (approximately 600 mL/h) and urine alkalinisation should also be considered in patients with severe 2,4-dichlorophenoxyacetic acid and mecoprop poisoning (pg 76). Grade D, Level 3 D Volume overload may complicate (...) individuals or in those with coronary and cerebral arterial disease (pg 77). Grade D, Level 4 D Urinary acidi? cation (urine pH 4 mL. Grade D, Level 3 C If the accidental ingestion occurred >12 hours (24 hours for enteric-coated tablets) and the patient is asymptomatic, no further evaluation is required (pg 100). Grade C, Level 2+ Mucocutaneous and ocular salicylate exposure D For asymptomatic patients with dermal exposures to methyl salicylate or salicylic acid, the skin should be thoroughly washed

2020 Ministry of Health, Singapore


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