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Coma Exam

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301. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee

and diagnosing biliary causes of AP. MRI/MRCP using secretin is helpful in examining the ductular system in the pancreas as well as common bile duct abnormalities including strictures or stones (61,62). To optimize detection of ductal abnormalities, MRCP may be performed after an attack of AP has resolved as acute edema may obscure the visualization of the ducts. The use of secretin-enhanced MRCP in pediatric pancreatic disease has not been fully established (63) and access to secretin is not uniform across (...) translocation and thereby prevent the development of SIRS. Early nutritional therapy is also purported to decrease cytokine response and incidence of gastroparesis and intestinal ileus. Although some studies (120) show no difference in outcomes when EN was initiated before or after 72 hours of presentation, a 2008 meta- analysis examining 11 RCTs demonstrated that EN started within 48 hours of presentation significantly decreased rates of mortality, infections and multiorgan failure compared with PN (121

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

302. Appropriate Use Criteria: Imaging of the Head & Neck

and type 2, and other rare conditions (including hereditary hemorrhagic telangiectasia, multiple endocrine neoplasia, pseudoxanthoma elasticum) Mental status changes, with documented objective evidence from neurologic exam Syncope Evaluation for a structural brain lesion when associated with at least one of following: ? Documented abnormality on neurological examination ? Presence of at least one persistent neurological symptom ? Witnessed or highly suspected seizure activity at the time of the episode (...) sinus for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels for pain or radicular indications ¾ MRI foot and MRI ankle for pain indications ¾ Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical practice

2018 AIM Specialty Health

303. CRACKCast Episode 185 – Alcohol Related Disease

CRACKCast Episode 185 – Alcohol Related Disease CRACKCast Episode 185 - Alcohol Related Disease - CanadiEM CRACKCast Episode 185 – Alcohol Related Disease In by Chris Lipp June 11, 2018 This episode of CRACKCast covers Rosen’s Chapter 142 (9th Edition), Alcohol Related Disease. This chapter covers the spectrum of alcohol use, including effects of mild, moderate, and severe use disorders, including prevention, screening, diagnosis and management. We also examine the wide variety of complications (...) are found on the GABA receptor complex. Chronic ethanol use induces an insensitivity to GABA such that more inhibitor is required to maintain a constant inhibitory tone. As alcohol tolerance develops, the individual retains arousal at alcohol concentrations which would normally produce lethargy or even coma in relatively alcohol naïve individuals. Cessation of alcohol or a reduction from chronically elevated concentrations results in decreased inhibitory tone. Excitatory amino acids — Glutamate is one

2018 CandiEM

304. ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement Full Text available with Trip Pro

temperatures of 32°C, 33°C, and 34°C after ROSC for adults with OHCA and initial shockable rhythm. It is challenging to design a prospective clinical trial examining a goal-directed strategy that optimizes only 1 physiological parameter. One study currently underway in Belgium is the NEUROPROTECT trial (Neuroprotective Goal Directed Hemodynamic Optimization in Post-Cardiac Arrest Patients; NCT02541591). NEUROPROTECT is an adult prospective randomized study comparing a hemodynamic optimization strategy (...) prognosis: clinical examination, neurophysiological studies, blood biomarkers, and imaging studies. , There were specific knowledge gaps about prognostic tests and global concerns related to the design of prognosis studies. First, understanding how sedative drugs and neuromuscular blocking drugs alter prognostic testing requires prospective studies on drug pharmacokinetics and pharmacodynamics in postcardiac arrest patients, especially those treated with temperatures below normal. Next, studies

2018 American Heart Association

305. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease Full Text available with Trip Pro

surgery) or could be used as a bridge to other therapy, such as heart transplantation. 7,8 The purpose of this consensus statement is to high- light the unique aspects of cardiac resuscitation in chil- dren with congenital and acquired heart disease and to provide evidence-based recommendations for modify- ing resuscitation for this high-risk patient population to improve survival. The management of specific phases of cardiac arrest (prearrest, arrest, and postarrest stabiliza- tion) is examined (...) of trends and changes in continuously measured hemodynamic variables (eg, invasive systemic arterial and central venous pressures [CVPs], heart rate), physical examination, and specific laboratory tests. Lab- oratory data that can reveal inadequate cardiac output include direct or estimated measurements of Svo 2 , arte- rial blood gas analysis, and serum lactate assessment. The ECG can document the presence of ischemia or arrhythmias that can cause or result from low cardiac output. Echocardiography can

2018 American Heart Association

306. CRACKCast E173 – Infectious Diarrheal Disease and Dehydration

with infectious diarrhea is not recommended! Dehydration Assessment The degree of volume depletion is estimated from the history and physical examination findings. In severe dehydration, 20 mL/kg of 0.9% saline (or other appropriate isotonic crystalloid solution) given intravenously at a rapid rate should reverse signs of shock within 5 to 15 minutes. Repeated boluses of 20 mL/kg are indicated until clinical improvement occurs, but volume requirements greater than 60 mL/kg without signs of improvement suggest (...) examination of the patient should focus on signs of dehydration that may indicate another cause for the diarrhea: (e.g., otitis media, pyelonephritis, appendicitis, diabetic ketoacidosis), or signs that indicate the disease may have become extra-intestinal or systemic: Bone pain (osteomyelitis) Altered mental status (meningitis) Petechiae (hemolytic-uremic syndrome [HUS]) Refer to Table 172.8 in Rosen’s 9 th edition for the common causes of diarrhea in children. 5 important causes of diarrhea in children

2018 CandiEM

307. All-Terrain Vehicle Injuries, Prevention of

mandating use were developed. A query of MEDLINE, PubMed, Cochrane Library, and Embase for all-terrain vehicle injury was performed. Letters to the editor, case reports, book chapters, and review articles were excluded. Grading of Recommendations Assessment, Development, and Evaluation methodology was used to perform a systematic review and create recommendations. RESULTS Twenty-eight studies were included. Helmet use reduced traumatic brain injury (TBI). However, studies examining whether legislation (...) of safety measures and legislation on ATV-related injury prevention. Objectives The objective of this systematic review was to assess the scientific evidence on ATV-related injury prevention strategies for riders. While there are myriad studies examining injury patterns, far fewer focus on injury prevention. For this study, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, which has been previously validated. [ ] The GRADE approach dictates a priori

2018 Eastern Association for the Surgery of Trauma

309. ACR/ASNR/SIR/SNIS Practice Parameter for the Performance of Endovascular Embolectomy and Revascularization in Acute Stroke

branches, including M3 and M4 (see Appendix). National Institutes of Health Stroke Scale (NIHSS) – A 42-point scale used to objectively and reproducibly quantify the severity of select symptoms caused by a stroke. The NIHSS is composed of 11 items, each of which scores a specific area of neurological function from 0 (not present) up to 4 (most severe). In the case of coma, certain scores (eg, those for ataxia) default to 0, so the maximum score in a comatose patient is 39 [20] (see Appendix). Acute (...) record includes clinically significant history, including indications for the procedure; premorbid functioning, ideally using mRS; degree of neurological impairment and other pertinent physical examination findings prior to treatment, including determination of NIHSS; and findings of pertinent diagnostic imaging studies. Specific postprocedure information that should be available within the medical record includes extent of angiographic recanalization, ideally using mTICI score, and degree

2018 Society of Interventional Radiology

310. Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

. Left ventricular systolic dysfunction, heart failure, and stroke risk 47 Table 20. Mini-Mental Status Examination and stroke risk 47 vii Table 21. C-statistics from studies comparing stroke risk scores of interest 48 Table 22. Strength of evidence domains for prediction of thromboembolic risk 57 Table 23. Description and interpretation of included bleeding risk scores 60 Table 24. Summary of results for studies evaluating BRI among patients on warfarin 62 Table 25. Summary of results for studies

2018 Effective Health Care Program (AHRQ)

311. Imaging Guidelines

a primary adjunct to rapidly diagnose immediate life-threatening injuries. Computed tomography (CT) and magnetic resonance imaging (MRI) later became additional imaging modalities important for injury diagnosis and management. By the early 90s, bedside abdominal examination with Focused Assessment with Sonography in Trauma (FAST) largely replaced diagnostic peritoneal lavage as the primary imaging modality for rapid assessment of intra-abdominal hemorrhage in unstable trauma patients. This guideline (...) for pneumothorax and hemothorax. 1 Extremity radiographs remain an important secondary adjunct for diagnosis of extremity orthopaedic injury. A best practice is interpretation of all radiographs concurrent with the trauma evaluation to facilitate timely treatment interventions. Computed Tomography Imaging Multi-detector computed tomographic (MDCT) imaging is now well established as the imaging modality of choice in hemodynamically stable patients following the secondary survey exam. Oral contrast

2018 American College of Surgeons

313. When and how to treat hyponatremia in the ED

”. No further details are available. Her medications include L-thyroxine, a statin and a thiazide diuretic. Vitals are normal. On exam, Marjorie is weak and is unable to sit up without assistance. Strength testing reveals bilateral weakness in the arms and legs. A walk test is not attempted. No focal neurological deficits are noted. Cardiac, respiratory, and abdominal exams are normal. Investigations are ordered and results reviewed. Electrolytes : sodium 110 mmol/L , potassium 3.4 mmol/L, chloride 76 mmol (...) be classified as acute (having developed over <48 hours) or chronic. 1 However, although there is some correlation between duration and severity, recent treatment algorithms classify hyponatremia by severity of symptoms. which more appropriately guides treatment in most cases 4 (see Treatment below). Severe : cardiorespiratory arrest, seizures, coma, deep somnolence Moderate : nausea, confusion, headache, vomiting In adults, the most common causes of hyponatremia include thiazide use, SIADH, primary

2018 CandiEM

314. Practice Guideline Update Systematic Review Summary: Disorders of Consciousness

, University of Rochester Medical Center, Rochester, NY 8. Indiana University Department of Physical Medicine & Rehabilitation, University of Indiana School of Medicine, Indianapolis, IN 9. Coma Science Group - GIGA Research and Department of Neurology, Sart Tillman Liège University & University Hospital, Liège, Belgium 10. Department Neurology, Uniformed Services University of Health Sciences, Bethesda, MD; Department of Neurology, Johns Hopkins University, Baltimore, MD 11. James A. Haley Veterans (...) Medical Inc. and Enspire DBS, Inc. (Cleveland, Ohio); is listed as inventor for multiple patents held by Cornell University; receives royalties for Plum and Posner’s Stupor and Coma, Oxford University Press; and holds 0.25% stock option in Enspire DBS, Inc (no current value). J. Whyte served on a scientific advisory board for INTRuST; received funding for travel and honoraria from several noncommercial institutions for academic lectures; performs diagnostic behavioral assessments of patients with DoC

2018 American Academy of Neurology

315. Stroke in childhood - clinical guideline for diagnosis, management and rehabilitation

FVL Factor V Leiden GAS Goal Attainment Scaling GCS Glasgow Coma Scale GDG Guideline development group GOS Glasgow Outcome Scale GRADE methodology Grading of Recommendations Assessment, Development and Evaluation HAMLET Hemicraniectomy after MCA infarction with life-threatening edema trial HASU Hyperacute stroke unit HbS Sickle haemoglobin HCY Homocystinuria HR Heart rate HLA Human leukocyte antigen HS Haemorrhagic stroke HSCT Hematopoietic stem cell transplantation ICA Internal carotid artery ICF (...) recommendations, see Chapter 4.1 here. Acute management (chapter 5) Acute assessment (Chapter 5.1) • Use the Paediatric National Institute of Health Stroke Scale (PedNIHSS) and age- appropriate Glasgow Coma Scale (GCS) or AVPU (‘Alert, Voice, Pain, Unresponsive’) to assess the child’s neurological status and conscious level respectively. To access full recommendations, see Chapter 5.1 here. Framework for early functional assessment (Chapter 5.2) • Provide clinical assessment of a child’s body structures

2017 Royal College of Paediatrics and Child Health

316. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units: HAI-Net ICU protocol, version 2.2

References 28 Annex 1. Microorganisms code list 29 Annex 2. Extended antimicrobial resistance data for ICU-acquired infections 32 Annex 3. Healthcare-associated infections code list 33 Annex 4. Antimicrobial ATC codes 34 Diagnosis (site) code list for antimicrobial use 39 Annex 5. Risk scores definitions: SAPS II, APACHE II, Glasgow 40 SAPS II score 40 SAPS II weights 41 APACHE II score 41 Glasgow Coma Score 43 Other scoring systems 44 Annex 6. List of HAI outcome indicators 45 Annex 7. Structure (...) include registered nurses involved in bedside patient care. Students are not included. A ‘registered nurse’ is a nurse who has graduated from a college’s nursing program or from a school of nursing and has passed a national licensing exam to obtain a nursing license. Also include ‘agency nurses’, ‘bank nurses’, ‘interim nurses’ or other registered nurses who are not permanently employed for that position in the hospital. Total number of nursing assistant hours in ICU over seven day period: total

2017 European Centre for Disease Prevention and Control - Technical Guidance

318. Sepsis: recognition, diagnosis and early management

, are available. 1.3.5 Only measure blood pressure in children under 12 years in community settings if facilities to measure blood pressure, including a correctly-sized cuff, are available and taking a measurement does not cause a delay in assessment or treatment. 1.3.6 Measure oxygen saturation in community settings if equipment is available and taking a measurement does not cause a delay in assessment or treatment. 1.3.7 Examine people with suspected sepsis for mottled or ashen appearance, cyanosis (...) of the skin, lips or tongue, non-blanching rash of the skin, any breach of skin integrity (for example, cuts, burns or skin infections) or other rash indicating potential infection. 1.3.8 Ask the person, parent or carer about frequency of urination in the past 18 hours. 1.4 Stratifying risk of severe illness or death from sepsis 1.4.1 Use the person's history and physical examination results to grade risk of severe illness or death from sepsis using criteria based on age (see tables 1, 2 and 3). Adults

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

319. Spinal injury: assessment and initial management

of osteoporosis – for example steroid Spinal injury: assessment and initial management (NG41) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 24use suspected spinal fracture in another region of the spine abnormal neurological symptoms (paraesthesia or weakness or numbness) on examination: abnormal neurological signs (motor or sensory deficit) new deformity or bony midline tenderness (on palpation) bony midline (...) or absent sensation in the hands or feet priapism in an unconscious or exposed male. 1.9.2 If possible, record information on whether the assessments show that the person's condition is improving or deteriorating. 1.9.3 Record pre-alert information using a structured system and include all of the following: the patient's age and sex time of incident mechanism of injury injuries suspected signs, including vital signs and Glasgow Coma Scale treatment so far estimated time of arrival at emergency

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

320. Tuberculosis

vaccination, including: case definition for at-risk groups to be offered vaccination information about the local BCG vaccination policy that can be given verbally, in writing or in any other appropriate format (see sections 1.1.1 and 1.1.2) to parents and carers at the routine examination of the baby before discharge local service information about BCG vaccination, such as pre-discharge availability of neonatal vaccination, local BCG clinics and referral for BCG vaccination if this is not available (...) recommendation 1.3.2.1). 1.3.4.3 Either a paediatrician with experience and training in TB or a general paediatrician with advice from a specialised clinician should investigate and manage TB in children and young people. [new 2016] [new 2016] 1.3.4.4 An expert in paediatric TB may request interferon-gamma release assays and tuberculin skin tests. Interpret these together with other diagnostic tools (such as history taking, clinical examination and imaging). [new 2016] [new 2016] 1.3.5 1.3.5 Diagnosing e

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

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