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Common Clotting Pathway

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

. The most important factor in stroke care in adults is being managed on a stroke unit by staff with specific expertise and interest in the disease. Stroke units have never been tested for childhood stroke and as a result are not even mentioned in these guidelines. Clot busting treatment for ischemic stroke, or clot removal, are becoming mainstays of care in adults, yet there is very little evidence for these treatments in children because research has not been done. These guidelines are the first stage (...) , which gives recommendations on how best to support children who had a stroke and also importantly their family. The parent and carer input is a very welcome edition. This clinical guideline is the most comprehensive and up to date document on how stroke care should be provided, covering the whole care pathway from identification, diagnosis and management of children and young people with arterial ischaemic stroke and haemorrhagic stroke until their transition to adult care. It is aimed

2017 Royal College of Paediatrics and Child Health

62. WHO recommendations: intrapartum care for a positive childbirth experience

WHO recommendations: intrapartum care for a positive childbirth experience WHO recommendations Intrapartum care for a positive childbirth experience WHO recommendations Intrapartum care for a positive childbirth experienceWHO recommendations Intrapartum care for a positive childbirth experienceWHO recommendations: intrapartum care for a positive childbirth experience ISBN 978-92-4-155021-5 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons (...) your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance

2018 World Health Organisation Guidelines

63. Treatment of Malignant Pleural Mesothelioma

. The randomized clinical trial demonstrating benefit with bevacizumab used cisplatin/pemetrexed; data with carboplatin/pemetrexed plus bevacizumab are insufficient for a clear recommendation (Type of recommendation: evidence based; Evidence quality: high; Strength of recommendation: moderate) Recommendation 3.2: Bevacizumab is not recommended for patients with PS 2, substantial cardiovascular comorbidity, uncontrolled hypertension, age > 75, bleeding or clotting risk, or other contraindications to bevacizumab (...) with suspected MPM presents with a pleural effusion, the diagnostic work-up should begin with an ultrasound-guided thoracentesis with pleural fluid sent to cytopathology for analysis. Although less than one third of MPM can be diagnosed accurately on pleural fluid cytology, thoracentesis is a safe and reliable initial intervention that can also transiently alleviate the common presenting symptoms of dyspnea and chest discomfort. The diagnostic utility of thoracentesis is principally limited

2018 American Society of Clinical Oncology Guidelines

65. Sirens to Scrubs: Acute Coronary Syndromes, Part Two – To the Lab!

in the prehospital environment for patients with ACS? Read on to find out… About Sirens to Scrubs Sirens to Scrubs was created with the goal of helping to bridge the disconnect between pre-hospital and in-hospital care of emergency patients. The series offers in-hospital providers a glimpse into the challenges and scope of practice of out-of-hospital care while providing pre-hospital providers with an opportunity to learn about the diagnostic pathways and ED management of common (or not-so-common) clinical (...) of additional platelet and aggregation, forming platelet plugs. Thus, Aspirin prevents further clot formation, preventing the growth of the troublesome thrombus. Nitroglycerin mimics the actions of endogenous nitric oxide, increasing the levels of intracellular cGMP. Raised levels of intracellular cGMP inhibit the entry of calcium into cells, which is the causative mechanism in the induction of vascular smooth muscle relaxation. Although generally described as a ‘symptom-relief medication’, a 2009 Cochrane

2018 CandiEM

66. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

a cerebral embolic clot markedly decreases after 6 to 8 hours. This implies that anticoagulants will have a hard time lysing a clot after 8 hours. Given the 4-hour time to peak effect with LMWH, the time to subsequent dosing following catheter manipulation would be 8 hours minus 4 hours, or 4 hours. The American Society of Regional Anesthesia and Pain Medicine has consistently incorporated FDA-approved labeling into practice recommendations and as such adopted the changes. This time interval is also (...) %) of the 61 cases, either a clotting abnormality or needle placement difficulty was present. A spinal anesthetic was performed in 15 patients. The remaining 46 patients received an epidural anesthetic, including 32 patients with an indwelling catheter. In 15 of these 32 patients, the spinal hematoma occurred immediately after the removal of the epidural catheter. Nine of these catheters were removed during therapeutic levels of heparinization. Neurologic compromise presented as progression of sensory

2018 American Society of Regional Anesthesia and Pain Medicine

67. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

) the response of the neonate and the postoperative patient with complex CHD to phar- macological intervention can differ from the response of infants and children without heart disease. There is a wide spectrum of cardiac disease in infants and children. Cardiac disease in infants and children is primarily congenital but can be acquired. In many cir- cumstances, the heart defects are surgically corrected or palliated, but blood flow pathways are not normal. Patients can carry the burden of residual lesions (...) ) admin- istration of vasoactive agents to maximize shunt per- fusion pressure (eg, phenylephrine, norepinephrine, epinephrine); (3) anticoagulation with heparin (50–100 U/kg bolus) to prevent clot propagation 22,24 ; (4) shunt intervention by catheterization or surgery; and (5) sta- bilization with ECLS. In patients with shunt obstruc- tion, maneuvers to decrease PVR (eg, oxygen, inhaled nitric oxide [iNO]) will provide little benefit and could delay the diagnosis of the actual problem. Reduction

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2018 American Heart Association

68. CRACKCast Episode 185 – Alcohol Related Disease

clotting factors, GI variceal formation, and vitamin K deficiency Comorbid substance use disorders: Smoking, cocaine, NSAIDs Increased risk for dieulafoy’s lesions GI trauma from withdrawal or intake leading to mallory-weiss syndrome (or another cause of vomiting such as pancreatitis) [15] List 8 metabolic/electrolyte effects from chronic alcohol use Poor oral intake; intestinal pathology: Diarrhea and impaired intestinal absorption are common problems of the chronic alcoholic. Alcohol increases small (...) -Ar scale. Rosen’s in Perspective Anyone who works in the ER knows well the epidemic extent of alcoholism. Alcohol is the most common recreational drug taken by Americans, and per capita consumption is increasing. Alcohol is the third leading cause of preventable death in the United States; alcoholism permeates all levels of society and is a preventable cause of morbidity and mortality. Today we’ll touch on the key points for four emergent alcohol withdrawal syndromes; here’s a signpost: [1

2018 CandiEM

69. The use of viscoelastic haemostatic assays in the management of major bleeding

to motion from the viscoelastic fluid is detected by an electromechanical transducer. Figure provided courtesy of Sienco Inc, Morrison, CO, USA. Table 1. TEG reagents TEG 5000 (cup and pin method) TEG 6s (cartridge method) What the trace looks at: Sample type Fresh WB Citrated WB Citrated WB – Tests available ‘Plain cup’: Kaolin CK: Kaolin, Ca Standard clot formation – activating the intrinsic pathway ‘Heparinase cup ’ : Kaolin, heparinase CKH: Kaolin, heparinase, Ca When compared to a standard kaolin (...) activated trace a shorter R time suggests the presence of heparin rTEG: Kaolin, TF CRT: Kaolin, TF, Ca Standard clot formation activating both intrinsic and extrinsic pathways (particularly helpful for major haemorrhage and rapid results) FF: TF, Reopro CFF: TF, Reopro, Ca Platelet inhibitor added: contribution of fibrinogen to clot remains. When trace is compared to a standard kaolin trace the platelet contribution can be estimated The words in italics indicate the names given to the assays

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2018 British Committee for Standards in Haematology

70. Perineal care

without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable. © State of Queensland (Queensland Health) 2018 This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Australia. In essence, you are free to copy and communicate the work (...) Queensland Clinical Guideline: Perineal care Refer to online version, destroy printed copies after use Page 8 of 39 1 Introduction Perineal injury is the most common maternal morbidity associated with vaginal birth. 2 In Queensland in 2016, 73.5% of women who had a vaginal birth experienced perineal trauma and of these, 57.2% required surgical repair. 3 1.1 Women’s Healthcare Australasia (WHA) Table 1. Australian context Aspect Consideration Australian Context · In Australia, the reported rate

2018 Queensland Health

71. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

with age. Igarashi et al demonstrated blood vessel trauma in 28% of patients who underwent an epidural puncture at L2–L3. The size of the venous plexus changes with the segmental localization of the anastomoses. Large-diameter anastomoses exist at the C6–7, superior thoracic, and entire lumbar regions. These vessels are often located at sites of common interventional pain procedures. In addition, venous plexus distention can occur with anatomical changes in the spinal canal including adjacent level (...) enhancement of fibrinolysis. Aspirin, unlike non-ASA NSAIDs, decreases thrombin formation in clotting blood. Aspirin at higher doses prevents endothelial cell prostacyclin production by inhibiting COX-2. Prostacyclin inhibits platelet coagulation and stimulates vasodilation. | Phosphodiesterase Inhibitors Phosphodiesterase (PDE) inhibitors are also used as antiplatelet therapies. Platelets express 3 PDE isoenzymes: PDE-2, PDE-3, and PDE-5. Two commonly encountered PDE inhibitors are dipyridamole, which

2018 American Society of Regional Anesthesia and Pain Medicine

72. Sirens to Scrubs: Acute Coronary Syndrome – Beyond Door-to-Balloon

to Scrubs was created with the goal of helping to bridge the disconnect between pre-hospital and in-hospital care of emergency patients. The series offers in-hospital providers a glimpse into the challenges and scope of practice of out-of-hospital care while providing pre-hospital providers with an opportunity to learn about the diagnostic pathways and ED management of common (or not-so-common) clinical presentations. By opening this dialogue, we hope that these new perspectives will be translated (...) (the inner lining) of coronary arteries, resulting in physiological derangements causing increased clotting and impaired vasodilation. With the damage to the endothelium, inflammatory cells, including macrophages, are able to migrate into the artery wall in the area just below the endothelium called the subendothelium. Amongst other mechanisms beyond the scope of a short review, these macrophages consume and digest low-density lipoproteins (LDL), transforming into foam cells and contributing

2018 CandiEM

73. Management of Pregnancy

and well-being by guiding health care providers who are taking care of pregnant women along the management pathways that are supported by evidence. The expected outcome of successful implementation of this guideline is to: • Assess the condition of the mother and baby and determine the best management method in collaboration with the mother and, when possible and desired, other family and caregivers • Optimize the mother and baby’s health outcomes and improve quality of life • Minimize preventable (...) the past 25 years, maternal pregnancy-related mortality and morbidity have been increasing. Common complications that can occur during pregnancy include maternal obesity or excessive weight gain, mental health conditions (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), hyperemesis gravidarum, anemia, gestational diabetes mellitus (GDM), and hypertensive disorders of pregnancy (e.g., gestational hypertension, preeclampsia, eclampsia).[ ] 9 Pregnancy-related deaths (approximately 600

2018 VA/DoD Clinical Practice Guidelines

74. AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement

in the last decade. Training for TAVR should occur by 1 of 2 pathways: 1) a formal training program incorporated into cardiology fellowship or cardiovascular surgical residency or 2) formal proctorship wherein an established interventional cardiologist or cardiac surgeon participates in an established TAVR program under the tutelage of an experienced team. Ongoing education courses with didactics focused on new concepts of TAVR, hands-on experience with device-specific equipment; simulation, viewing live (...) and cardiopulmonary bypass machine f. Minimum room size of 800 square feet (74.3 m 2 ) to accommodate the standard equipment required in a cardiac catheterization laboratory (e.g., high-definition displays and monitors, ultrasound machine for access, O 2 analyzer and supply, defibrillator/resuscitation cart, suction, compressed air, CO-oximeter, activated clot- ting time analyzer) as well as echocardiographic equipment, sonographers, anesthesia equipment, emergency CT surgical team and cardiopulmonary bypass

2018 Society for Cardiovascular Angiography and Interventions

75. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications

and factors influencing the gut microbiota (box 1) (GRADE of evidence: low; strength of recommenda- tion: strong). Laboratory screening of potential donors Blood and stool screening of donors is mandatory (boxes 2 and 3) (GRADE of evidence: low; strength of recommendation: strong). Repeat donor checks, and donation pathway i. In centres using frozen FMT, before FMT may be used clin- ically, we recommend that donors should have successful- ly completed a donor health questionnaire (...) of chronic pain syndromes, including chronic fatigue syndrome and fibromyalgia. 12. History of any malignancy. 13. Taking particular regular medications, or such medications within the past 3 months—that is, antimicrobials, proton pump inhibitors, immunosuppression, chemotherapy. 14. History of receiving growth hormone, insulin from cows or clotting factor concentrates. 15. History of receiving an experimental medicine or vaccine within the past 6 months. 16. History of travel to tropical countries

2018 British Society of Gastroenterology

76. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome

in the ACS population, as has been demonstrated in patients with stable ischemic heart disease. Healthcare Costs The impact of TRA and related patient care pathways on healthcare costs is an evolving topic and the focus of active investigation but is also limited in data specific to the management of patients with ACS. Current data suggest that cost savings related to TRA are derived primarily from lower vascular and bleeding complication rates, shorter average intensive care unit and hospital lengths (...) of active chest discomfort at rest during PCI for ACS. Analgesia Alleviating discomfort and anxiety is an important factor that helps prevent stimulation of central neural pathways and arterial vasoconstriction. , Administration of a low dose of a combination of fentanyl and midazolam has been shown to reduce patient discomfort, the incidence of RA spasm (2.6% versus 8.3%; P <0.001), and access site crossover (9.9% versus 15.0%; P =0.001) compared with control. Administration of topical lidocaine may

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2018 American Heart Association

77. Guideline Supplement: Primary postpartum haemorrhage

guideline development processes 7 Table 5. Levels of evidence and grades of recommendation 8 Table 6. Summary recommendations 9 Table 7. NSQHS Standard 1 11 Table 8. Clinical quality measures 11 Table 9. NSQHS/EQuIPNational Criteria 12 © State of Queensland (Queensland Health) 2018 This work is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 3.0 Australia licence. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes (...) ? Removed: o Emergency donor panel o Blood transfusion administration o PPH proforma ? Added: o Point of care blood clot analyser use o Fibrinogen concentrate o Tranexamic acid administration o Prophylactic misoprostol o Requirements and actions for low resource settings March 2018 MN18.1V7-R23 ? Amendment to flowchart Initial response to PPH o Added: Dose of carboprost if administered intramyometrial (500 micrograms) Queensland Clinical Guideline Supplement: Primary postpartum haemorrhage Refer

2018 Queensland Health

78. Management Of Haemophilia

these activities are preferably carried out within 24-hour of factor infusion. • Sports and physical fitness are important to maintain good muscle tone to protect the joints from the haemophilic-induced injuries, and these activities contribute to improvement in quality of life. 1 Management of Haemophilia 1. INTRODUCTION Haemophilia is a group of inherited blood disorders in which there is life-long defect in the clotting mechanism. The most common types of haemophilia are haemophilia A (factor VIII (...) adequate education and training. This is followed by close supervision of its safety and efficacy. Education should include: 2 - general knowledge of haemophilia - recognition of bleeds and common complications - first aid measures - dosage calculation, preparation, storage and administration of clotting factor concentrates - aseptic techniques and venepuncture techniques (or access of central venous catheter) - record keeping - proper storage and disposal of needles/sharps, and handling of blood

2018 Ministry of Health, Malaysia

79. Urological Trauma

from injury is twice as common in males, especially in relation to motor vehicle accidents (MVAs) and interpersonal violence. Trauma is therefore a serious public health problem with significant social and economic costs. Significant variation exists in the causes and the effects of traumatic injuries between geographical areas, and between low, middle, and high-income countries. It should be noted that alcohol and drug abuse increase the rate of traumatic injuries by precipitating interpersonal

2018 European Association of Urology

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