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141. Management of Poisoning

It is estimated that 350,000 people died worldwide from unintentional poisoning in 2002. 1 In Singapore, injuries (including poisoning) ranked as the ? fth leading cause of death and the leading cause of hospitalisation from 2007 to 2009. The pattern of poisoning has changed as the public is now exposed to other new drugs and chemicals. New antidotes and therapies have also been developed for the management of such poisoning, and are now available to health professionals. The Ministry of Health released its (...) therapy in patients with pre- existing cardiac disease. Signi? cant pre-existing heart disease is a relative contraindication. Urinary pH manipulation is contraindicated in patients with established or incipient renal failure, pulmonary oedema and cerebral oedema (pg 77). Grade D, Level 47 D Hypokalemia is the most common complication. Alkalotic tetany occurs occasionally, but hypocalcaemia is rare. There is no evidence to suggest that relatively short-duration alkalemia poses a risk to life in normal

2020 Ministry of Health, Singapore

142. ISHLT Consensus Statement on Donor Organ Acceptability and Management in Pediatric Heart Transplantation Full Text available with Trip Pro

tolerance of the catecholamine surge that occurs following a rise in intracranial pressure. x 75 Cohen, O, De La Zerda, DJ, Beygui, R, Hekmat, D, and Laks, H. Donor brain death mechanisms and outcomes After heart transplantation. Transplant Proc . 2007 ; 39 : 2964–2969 Some pediatric studies have demonstrated slightly higher 1-year mortality rates utilizing donors from cerebrovascular accidents, x 29 Zafar, F, Jaquiss, RD, Almond, CS et al. Pediatric Heart Donor Assessment Tool (PH-DAT): a novel donor (...) , Gibbons, E, and Vavilala, MS. Cardiac dysfunction following brain death in children: prevalence, normalization, and transplantation. Pediatr Crit Care Med . 2015 ; 16 : e107–e112 , x 23 Rizwan, R, Zafar, F, Bryant, R et al. The number of refusals for donor organ quality does not impact heart transplant outcomes in children. Ann Thorac Surg . 2018 ; 105 : 1223–1230 , x 24 Madan, S, Saeed, O, Shin, J et al. Donor troponin and survival after cardiac transplantation: an analysis of the United Network

2020 International Society for Heart and Lung Transplantation

143. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children Full Text available with Trip Pro

is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website ( ). Drs. Weiss and Peters served as arbiters for conflict interest management and adjudication throughout the guidelines process following standard operating procedures set forth by Society of Critical Care Medicine (SCCM) and endorsed by European Society of Intensive Care Medicine. Dr. Weiss participates in Pediatric Acute Lung Injury (...) and Sepsis Investigators (PALISI) and Shock Society. Dr. Peters participates in the UK PICS study group (vice-chair) and has testified as an expert witness in cases of clinical negligence, causation of injuries. Dr. Agus participates in the American Academy of Pediatrics (AAP), Pediatric Academic Societies (PAS), American Pediatric Society, Society for Pediatric Research, and The American Society for Clinical Investigation, and he has testified as an expert witness in cases related to ICU

2020 Society of Critical Care Medicine

144. SCAI Multi-Society Position Statement on Occupational Health Hazards of the Catheterization Laboratory

occupational radiation exposure is associated with health risks to physicians, nurses, and technologists working in this environment. Health care workers are subject to insidious health effects of radiation exposure over many years. Adverse effects include the established predilection to posterior subcapsular cataracts, as well as worrisome signals of lifetime risks of cancer induction, particularly in the unprotected brain. - A further consequence is the extensively documented incidence of orthopedic (...) illnesses reported in physicians as well as nurses and technologists and injuries linked to the cumulative burden of bearing the weight of only partly protective lead aprons mandatory to reduce radiation risk. - The increased volume and complexity of procedures, together with the physical stresses inherent in procedural performance, have exacerbated the prevalence and magnitude of such orthopedic injuries. The high prevalence of orthopedic afflictions not only affects individual health but also could

2020 Society for Cardiovascular Angiography and Interventions

145. European Academy of Neurology guideline on the diagnosis of coma and other disorders of consciousness Full Text available with Trip Pro

and sometimes even years after the brain injury , - . It is thus unsurprising that as many as 40% of non‐communicating patients with DoC may be wrongly classified as being in the vegetative state/unresponsive wakefulness syndrome (VS/UWS) , , , . This has major ethical and practical implications for patients and their caregivers, including prognosis, treatment, resource allocation and end‐of‐life decisions - . Limited knowledge of DoC contributes to this dilemma. The classical locked‐in syndrome, in which (...) various cognitive tasks , - ; passive paradigms relying on the assessment of functional connectivity in response to external stimuli ; and assessment of spontaneous brain activity during rest , - . A number of active paradigm studies have shown that, although patients with severe brain injury may not reveal any signs of consciousness at the bedside, some of them are able to wilfully modulate their brain activity on command, even occasionally answering yes/no questions by performing mental imagery

2020 European Academy of Neurology

146. Small Intestinal Bacterial Overgrowth

bacterial overgrowth. Likewise, postsurgical changes such as gastrojejunostomy with a blind loop or injury to the vagus nerve may each provide an opportunity for bacterial overgrowth. Although strictures causing partial or fixed obstruction would be obvious causes of stagnation and have been considered to be risk factors for SIBO, there are currently no solid peer-reviewed publications validating this. Colectomy, either partial or complete, and especially with loss of the ileocecal valve, will allow

2020 American College of Gastroenterology

147. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

and likely play a direct role in the pathogenesis of the myocardial inflammation, either alone or in concert with a propensity toward specific viral insults. Laboratory Evaluation in Myocarditis The ECG in FM may demonstrate low QRS voltage because of myocardial edema; rarely, there is evidence for left ventricular (LV) hypertrophy. Electrocardiographic signs of an injury current with ST-segment elevations in contiguous leads in a segmental fashion are not uncommon and may mimic coronary occlusion (...) , inflammation, or injury even at a subclinical level (eg, extracellular volume fraction mapping and T1/T2 mapping) have emerged as diagnostic adjuncts. These techniques allow quantification of CMR relaxation parameters along a continuum with precision, reflecting the degree of inflammation or fibrosis occurring below the thresholds of traditional LGE or T1/T2–weighted imaging. Indeed, the addition of tissue mapping (extracellular volume fraction or T1 mapping) yielded significant improvement in diagnostic

2020 American Heart Association

148. Disorders of the Hepatic and Mesenteric Circulation Full Text available with Trip Pro

are some of the final steps in the dissolution of the clot. Diagram of normal clotting process: vessel injury, platelet plug formation, and clot development and defects observed in cirrhosis. The net balance of procoagulant and anticoagulant factor pathways governs whether there is propagation or abortion of a protective or pathological clot which is then further governed by the simultaneously activated thrombolytic (fibrinolytic) plasmin-based pathways which govern clot remodeling and/or clot (...) that reversing agents are now available for all the major DOACs. Key concepts 6. Pharmacologic prophylaxis against DVT seems to be safe in hospitalized cirrhotic patients in the absence of bleeding or platelet counts less than 50,000/μL). PORTAL AND MESENTERIC VEIN THROMBOSIS IN PATIENTS WITH AND WITHOUT CIRRHOSIS Etiology and prevalence As with any other vascular system, thrombosis of the portal and/or mesenteric veins is related to Virchow's triad including endothelial injury, sluggish blood flow or stasis

2020 American College of Gastroenterology

149. Treatment for Insomnia and Disrupted Sleep Behavior in Children and Adolescents with Autism Spectrum Disorder

, the SickKids Foundation, Cerebral 15 Palsy Alliance Foundation, and Kids Brain Health Network for research in cerebral palsy; serves 16 on the data safety monitoring board for AveXis; has received financial compensation for 17 consulting work for Biogen and Roche; and has received research support as site principal 18 investigator for Ionis, Biogen, Roche, and Cytokinetics for clinical trials in spinal muscular 19 atrophy. 20 M. Armstrong serves on the Level of Evidence editorial board for Neurology (...) . Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA 24 2 7. Departments of Pediatrics and Psychiatry, The Ohio State University College of 1 Medicine, Columbus 2 8. Duke Center for Autism and Brain Development, Duke Institute for Brain Sciences, and 3 Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 4 Durham, NC 5 9. Northern Michigan Neurology, Traverse City 6 10. Department of Child and Behavioral Sciences, Johns Hopkins University

2020 American Academy of Neurology

150. Society of Interventional Radiology Position Statement on the Role of Percutaneous Ablation in Renal Cell Carcinoma. Full Text available with Trip Pro

was associated with decreased median hospital length of stay and decreased median blood loss. The rates of urine leak, acute kidney injury, and “other urologic complications” were higher in PN versus ablation. The median percentage of urine leak and acute kidney injury were 0% and 0%, respectively, for ablation, and 2.6% and 2.1%, respectively, for PN. Renal function outcomes were similar between PN and ablation, with low strength of evidence. Compared to PN, ablation offers similar CSS with fewer (...) in distant sites ( x 6 Capitanio, U., Bensalah, K., Bex, A. et al. Epidemiology of renal cell carcinoma. Eur Urol . 2019 ; 75 : 74–84 | | | | | 6 , x 43 Choueiri, T.K. and Motzer, R.J. Systemic therapy for metastatic renal-cell carcinoma. N Engl J Med . 2017 ; 376 : 354–366 | | | 43 ). Distant metastases occur most frequently in the lungs, lymph nodes, liver, bone, and brain ( x 43 Choueiri, T.K. and Motzer, R.J. Systemic therapy for metastatic renal-cell carcinoma. N Engl J Med . 2017 ; 376 : 354–366

2020 Society of Interventional Radiology

151. Haemodialysis

kidney injury) finally with date and language restrictions ("1990/01/01"[dp]: "3000"[dp] AND english[lang]). Searches were conducted in MEDLINE, PUBMED, Embase, and The Cochrane Library, and supplemented with papers handpicked from the reference lists of review papers. The strengths of the recommendations and the level of supporting evidence are coded as previously using the Modified GRADE system. There are a few changes in scope, for example dialysis water treatment is now covered in another

2019 Renal Association

152. Alcohol-related trauma reinjury prevention with hospital-based screening in adult populations Full Text available with Trip Pro

patients diagnosed with mild traumatic brain injury. [22] All participants in the intervention group underwent a battery of tests such as AUDIT and other non–alcohol-related questionnaires. Patients in the intervention group had a significantly lower score on AUDIT at 3 months consistent with reduced hazardous alcohol use (5.2 vs. 9.6 at baseline; p = 0.01) compared with the usual care group. No studies overtly demonstrated harm or worse outcomes associated with SBIRT for adult trauma patients. However (...) intervention for mild traumatic brain injury (SWIFT-acute): a pilot study. Brain Inj . 2014;28(4):448–455. | Eyer MM, Renier CM, Woehrle TA, Vogel LE, Conway PG, McCarty CA. Alcohol use at the time of traumatic brain injury: screening and brief intervention in a community hospital. J Trauma Nurs . 2017;24(2):116–124. | | Maier RV, Mock C. Chapter 3 Injury Prevention. In: Mattox KL, Feliciano DV, Moore EE, eds. Trauma Seventh Edition . New York: Appleton & Lange:36–53. Schermer CR. Feasibility of alcohol

2020 Eastern Association for the Surgery of Trauma

153. Therapy for Stage IV Non-Small Cell Lung Cancer without Driver Alterations

for a particular use or purpose. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this information, or for any errors or omissions. Ontario Health (Cancer Care Ontario) Disclaimer Care has been taken in the preparation of the information contained herein. Nevertheless, any person seeking to consult the report or apply its recommendations is expected to use independent medical judgment in the context of individual clinical circumstances

2020 American Society of Clinical Oncology Guidelines

154. Treatment of Patients with Schizophrenia

symptoms (American Psychiatric Association 2013a). Worldwide, schizophrenia is one of the top 20 causes of disability (GBD 2017; Disease and Injury Incidence and Prevalence Collaborators 2018). Economic burdens associated with schizophrenia are high (Chapel et al. 2017; Jin and Mosweu 2017), with an estimated cost of over $150 billion annually in the United States based on 2013 data (Cloutier et al. 2016). Lost productivity due to unemployment and caregiving each account for approximately one-third (...) and mortality among individuals with schizophrenia. About 4%-10% of persons with schizophrenia die by suicide, with rates that are highest among males in the early course of the disorder (Drake et al. 1985; Heilä et al. 2005; Hor and Taylor 2010; Inskip et al. 1998; Laursen et al. 2014; Nordentoft et al. 2011; Palmer et al. 2005; Popovic et al. 2014; Saha et al. 2007; Tanskanen et al. 2018). Additional causes of death also include other unnatural causes, such as accidents and traumatic injuries

2020 American Psychiatric Association

155. Clinical practice guideline for evaluation of psychosocial factors influencing recovery from adult orthopaedic trauma

from Operation Iraqi Freedom and Operation Enduring Freedom. Journal of Orthopaedic Trauma. 2009; 23(4):261-6. 22. Abraham, C. M., Obremskey, W. T., Song, Y., Jackson, J. C., Ely, E. W., Archer, K. R. Hospital delirium and psychological distress at 1 year and health-related quality of life after moderate-to-severe traumatic injury without intracranial hemorrhage. Archives of Physical Medicine & Rehabilitation 2014; 12: 2382-9 23. Andrew, N. E., Gabbe, B. J., Wolfe, R., Williamson, O. D., Richardson (...) in the management of adult orthopaedic trauma. It is also intended to serve as an information resource for decision makers and developers of practice guidelines and recommendations. Although military personnel operate in the broader context of society, military service members exhibit a unique psychosocial profile that should be considered following orthopaedic injury (Strom, 2012, Kennedy, 2007). During the last decade, the disparity between civilians and active duty members has been highlighted

2020 American Academy of Orthopaedic Surgeons

156. Clinical practice guideline for limb salvage or early amputation

amputations had a higher risk of death. In Allami (2017), in veterans with ankle-foot injuries, having additional injuries was a determinant of poorer mental health and poorer PCS scores. In the study from Laferrier (2010) in a population of military polytrauma patients, an increasing number of combat injuries (including bilateral limb loss, traumatic brain injury) is associated with higher odds of wheelchair use. Laferrier also found that in patients with bilateral lower-limb loss compared to those (...) or by downloading to your smartphone or tablet via the Apple and Google Play stores! View background material via the LSA CPG eAppendix Page4 Table of Contents SUMMARY OF RECOMMENDATIONS 6 BURDEN OF INJURY 6 PSYCHOSOCIAL FACTORS 7 REHABILITATION 7 NERVE INJURY 7 MASSIVE SOFT TISSUE AND MUSCLE DAMAGE 7 VASCULAR INJURY/LIMB ISCHEMIA 8 SMOKING 8 LOWER EXTREMITY INJURY SCORES 8 AMPUTATION/LIMB SALVAGE 9 GUIDELINE DEVELOPMENT GROUP ROSTER 10 Voting Members 10 Non-Voting Members 10 INTRODUCTION 11 METHODS 15 Best

2020 American Academy of Orthopaedic Surgeons

157. Prenatal Care

], and administering it around 32 weeks may optimize maternal antibody formation peaking at normal time of delivery. No non-medically-indicated delivery 1.1 mg/dL or doubling of serum creatinine in the absence of other renal disease), pulmonary edema, or new onset cerebral or visual disturbances. • Chronic hypertension is hypertension that predates pregnancy. In patients without documentation of blood pressure prior to conception the diagnosis is suspected in the presence of two elevated pressures prior (...) renal insufficiency, pulmonary edema, or new onset cerebral or visual disturbances. If this develops at any gestational age, admit the patient to the hospital for further evaluation and management. Bed rest does not alter the course of preeclampsia. Laboratory and Other Tests Most initial prenatal laboratory tests should be collected during the prenatal period, even if previously collected during a preconception visit. 9 UMHS Prenatal Care Guideline, September 2018 Blood type and antibody status

2020 University of Michigan Health System

158. Special Topics in Venous Thromboembolism

or brain injury within 3 months Any known bleeding diathesis or internal bleeding Minor contraindications Systemic thrombolytic therapy with alteplase is generally not recommended in adults with acute PE when any of the following criteria are present: Prolonged cardiopulmonary resuscitation (CPR) Systolic BP > 180 mm Hg Diastolic BP > 110 mm Hg Recent non-intracranial bleeding (within 2-4 weeks) Recent surgery within 2 weeks Recent invasive procedure within 1 week Ischemic stroke or CVA > 3 months ago (...) significantly above baseline New or increasing myocardial necrosis with elevated serum troponin level Major contraindications Avoid systemic thrombolytic therapy with alteplase in adults with acute PE if any of the following criteria are present: Structural intracranial disease (i.e. arteriovenous malformation or aneurysm) Intracranial neoplasm Previous history of intracranial hemorrhage Ischemic stroke or CVA within 3 months Recent brain or spinal surgery within 3 months Recent head trauma with fracture

2020 University of Michigan Health System

159. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg . 1999;118(5):866-873. doi: Kudsk KA, Tolley EA, DeWitt RC, et al. Preoperative albumin and surgical site identify surgical risk for major postoperative complications. JPEN J Parenter Enteral Nutr . 2003;27(1):1-9. doi: Lee EH, Kim WJ, Kim JY, et al. Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery (...) artery bypass graft surgery. Stroke . 2002;33(2):537-541. doi: Groom RC, Rassias AJ, Cormack JE, et al; Northern New England Cardiovascular Disease Study Group. Highest core temperature during cardiopulmonary bypass and rate of mediastinitis. Perfusion . 2004;19(2):119-125. doi: Newland RF, Baker RA, Mazzone AL, Quinn SS, Chew DP; Perfusion Downunder Collaboration. Rewarming temperature during cardiopulmonary bypass and acute kidney injury: a multicenter analysis. Ann Thorac Surg . 2016;101(5):1655

2020 ERAS Society

160. The Combined Use of Ultrasound and Fetal Magnetic Resonance Imaging for a Comprehensive Fetal Neurological Assessment in Fetal Congenital Cardiac Defects

injury following surgery in certain patients. Socio‐economic and parental factors will also influence later intellectual development. , Increasingly, however, preoperative and prenatal brain dysgenesis, immaturity and white matter injury are being recognised in infants with CHDs. There is substantial clinical evidence of neurological developmental deficits prior to surgery in these infants, with this association more established in some cardiac defects, such as HLH. , There is a higher prevalence (...) of microcephaly in infants with HLH and the effect of surgery on further neurological deficit in this group is unclear. In addition to global delay, localised neurological deficits have been observed in all domains. Evidence from the neuroimaging literature demonstrates more than half of newborns with CHD (in high‐risk groups of HLH and TGA) have evidence of white matter brain injury, which are varyingly termed ischaemic lesions, white matter injury, focal stroke and periventricular leukomalacia

2019 Royal College of Obstetricians and Gynaecologists


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