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Cough fracture

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

of pulmonary sequestration (70). Standard pulmonary workup and care should be considered in any patient with unexplained shortness of breath, worsening cough and/or difficulty breathing (93). Renal Monitoring Acute kidney injury (AKI) via abdominal compartment syndrome (82,95) or inflammatory-driven damage to the proximal convoluted tubule (96) marked by elevation of BUN and creatinine, along with decreased urine output, is a known early complication of AP in children and factors prominently in AP scoring

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

142. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutritio

Dystonic neck posturing (Sandifer syndrome) Dental erosion Anemia Gastrointestinal Gastrointestinal Recurrent regurgitation with/ without vomiting in the older child Heartburn/chest pain y Epigastric pain y Hematemesis Dysphagia/odynophagia Esophagitis Esophageal stricture Barrett esophagus Airway Airway Wheezing Stridor Cough Hoarseness Apnea spells Asthma Recurrent pneumonia associated with aspiration Recurrent otitis media BRUE ¼ brief resolved unexplained event; GERD ¼ gastroesophageal re?ux (...) eosinophilic esophagitis, only presenting with cough or other respiratory symptoms (47–49). Therefore, the main reason for endoscopy in this population with extraesophageal symptoms is to uncover reflux masqueraders such as eosinophilic esophagitis. Endoscopy can also be used to relieve esophageal outlet obstruction (from fundoplication, and untreated or partially treated achalasia) causing stasis with resultant cough and aspiration, or to diagnose candida esophagitis in children treated with inhaled

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

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

bones, including detection of calvarial and facial bone fractures Common Diagnostic Indications This section begins with general indications for CT Head, followed by Neurologic Signs and Symptoms and Vascular indications. General Head/Brain Abnormal imaging findings Follow up of abnormal or indeterminate findings on a prior imaging study when required to direct treatment Acoustic neuroma Management of known acoustic neuroma when at least one of the following applies: ? Symptoms suggestive (...) and at least one of the following features is present: ? Age 65 or greater ? Retrograde amnesia ? At least two (2) episodes of emesis ? Evidence of open, depressed or basilar skull fracture ? Focal neurologic findings ? Glasgow coma score less than 15 or altered mental status ? High risk mechanism of injury ? Seizure Tumor (benign or malignant) Diagnosis of suspected tumor when supported by the clinical presentation Management (including perioperative evaluation) of established tumor when imaging

2018 AIM Specialty Health

144. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

restrictions. The effects of UI range from slightly bothersome to debilitating. Up-to-date data on the economic impact of UI in women are lacking, but the American College of Physicians estimated the costs of UI care in the United States at $19.5 billion in 2004 in their 2014 Clinical Practice Guideline, 2 and other estimates are even higher. 3 The most common types of UI that affect women include stress, urgency, and mixed. Stress UI is associated with an inability to retain urine during coughing

2018 Effective Health Care Program (AHRQ)

145. Exam Series: Guide to the Back Exam

Illness : Characterize the pain as acute (<6 weeks) or chronic (>6 weeks). Pain that has not improved despite treatment is a concerning symptom. A history of trauma increases the risk of fracture especially in the context of an elderly patient or a history of steroid use. Patient characteristics : Cancer and fragility fractures should be considered in elderly patients with back pain. Cancer should also be considered in pediatric patients, along with congenital abnormalities of the spine and infection (...) instability suggest neurologic pain. Typically pain that is progressive, unrelenting and unrelieved by rest is suspicious for a more serious cause of back pain including malignancy, infection or fracture. Associated symptoms : Bladder and bowel dysfunction including urinary retention with overflow incontinence, or fecal incontinence and/or saddle parasthesias or sensory loss suggests cauda equina. Infectious symptoms (fever, chills) and constitutional symptoms (fatigue, weight loss, night sweats) may

2018 CandiEM

146. CRACKCast E175 – Neurologic Disorders

, acute recurrent, chronic non-progressive, chronic progressive, and mixed. REMEMBER: The child’s history is the most important component to an accurate diagnosis Primary headache causes: Migraine headache Tension headache Cluster headache Chronic daily headache Secondary headache causes: Trauma (e.g., intracranial bleed, concussion, skull fracture) Structural (e.g., neoplasm, AVM) Systemic (e.g., hypertension, metabolic) Infection (e.g., meningitis, abscess, etc…) Toxic (e.g., medication ingestion (...) history! REMEMBER: Red Flags History of head trauma Symptoms of increased ICP – Valsalva/cough/strain Awakening from sleep Chronic progressive h/a Headache on awakening Occipital h/a No family headache of migraines [11] With regards to presentation and management, how are migraines different in children? ANSWER: Pediatric migraine headaches are more commonly bilateral Atypical or migraine variants are more common in children: Hemiplegic migraine Ophthalmoplegic migraine Basilar migraine “Alice

2018 CandiEM

148. Gastroesophageal Reflux Disease (GERD)

Signs of GERD Table 2. Alarm or Warning Signs Suggesting Complicated GERD Table 3. Lifestyle Modifications Chronic cough Elevate head of bed 6-8 inches Asthma Dysphagia Decrease fatty meals Recurrent sore throat Odynophagia Stop smoking Recurrent laryngitis GI bleeding Avoid recumbency or sleeping for 3-4 hours after eating Dental enamel loss Iron deficiency anemia Avoid certain foods: chocolate, alcohol, peppermint, caffeinated coffee and other beverages, onions, garlic, fatty foods, citrus, tomato (...) with GERD will not report the classic symptoms of heartburn and regurgitation. However, symptom frequency, duration and severity are equally distributed among patients with varying grades of esophagitis and Barrett’s esophagus and cannot be used reliably to diagnose complications of GERD. There may also be some symptom overlap with other conditions (non-cardiac chest pain, cough, etc.). PPI diagnostic test. A favorable symptomatic response to a short course of a PPI (once daily for two weeks

2018 University of Michigan Health System

149. CRACKCast E181 – Approach to the Geriatric Patient

Osteoporosis = fracture risk Lean body mass decreased = pharmacokinetic changes Immune Decreased antibodies = increased infections Decreased cell-mediated-immunity = increased infections CVS Decreased inotropy = impaired Cardiac Output Decreased chronotropy = impaired Cardiac Output Pulmonary Decreased VC Decreased compliance Hepatic Decreased hepatic blood flow = altered pharmacokinetics Decreased p450 enzymes = altered pharmacokinetics Renal Decreased renal cell mass = altered pharmacokinetics Decreased (...) Focal Weakness Acute Focal Causes ICH Ischemic Stroke SAH Tumor Acute Bilateral Causes Brainstem stroke SCI trauma infection neoplasm inflammatory Guillain-Barre Non-Focal Weakness Acute Non-Focal Causes cardiac delirium metabolic infection Chronic Non-Focal Causes anemia meds inflammation neurologic deconditioning malignancy [6] List 8 predisposing risk factors for sepsis in the elderly. See Figure 183.4 Delirium and Dementia Decreased gag and cough reflex (aspiration risk) Endocrine deficiency

2018 CandiEM

151. Urinary Incontinence

al. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol, 2004. 190: 324. 81. Lewicky-Gaupp, C., et al. “The cough game”: are there characteristic urethrovesical movement patterns associated with stress incontinence? Int Urogynecol J Pelvic Floor Dysfunct, 2009. 20: 171. 82. Shek, K.L., et al. The effect of childbirth on urethral mobility: a prospective observational study. J

2018 European Association of Urology

153. 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 ( 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 (...) tenderness (on percussion) midline or spinal pain (on coughing) on mobilisation (sit, stand, step, assess walking): pain or abnormal neurological symptoms (stop if this occurs). 1.1.8 Be aware that assessing children with suspected thoracic or lumbosacral spine injury is difficult and the child's developmental stage should be taken into account. When to carry out or maintain full in-line spinal immobilisation When to carry out or maintain full in-line spinal immobilisation 1.1.9 Carry out or maintain

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

154. Suspected cancer: recognition and referral

for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or or if they have ever smoked and have 1 or more of the following unexplained symptoms: cough fatigue shortness of breath Suspected cancer: recognition and referral (NG12) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 11 of 79chest pain weight loss appetite loss. [new 2015] [new 2015] 1.1.3 Consider an urgent (...) that suggest mesothelioma. [new 2015] [new 2015] 1.1.5 Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over, if: they have 2 or more of the following unexplained symptoms, or or they have 1 or more of the following unexplained symptoms and have ever smoked, or or they have 1 or more of the following unexplained symptoms and have been exposed to asbestos: cough fatigue shortness of breath chest pain Suspected cancer: recognition and referral

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

155. Diabetic foot problems: prevention and management

to local protocols. 1.7 Charcot arthropathy In Inv vestigation estigation 1.7.1 Be aware that if a person with diabetes fractures their foot or ankle, it may progress to Charcot arthropathy. 1.7.2 Suspect acute Charcot arthropathy if there is redness, warmth, swelling or deformity (in particular, when the skin is intact), especially in the presence of peripheral neuropathy or renal failure. Think about acute Charcot arthropathy even when deformity is not present or pain is not reported. Diabetic foot

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

156. Prescribing patterns of dependence forming medicines

Institute for Health and Care Excellence NTA National Treatment Agency for Substance Misuse Opioids One of the four types of DFM examined in this report. Opioids are substances that act on opioid receptors to produce morphine-like effects. Primarily used for pain relief, they are also used to suppress cough and diarrhoea and treat addiction. OPCS Classification of Interventions and Procedures (OPCS-4) is a statistical classification for clinical coding of hospital interventions and procedures undertaken

2017 Public Health Research Consortium

157. Hypnotics

be © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 1 of 4continued for a further 10 weeks. An observational study discussed in NICE's medicines evidence commentary on fracture risk associated with melatonin and other hypnotics has found that in people aged 45 years and over, receiving 3 or more melatonin prescriptions was associated with an increased risk of fracture compared with no use of any hypnotic drugs (...) . Prescriptions for 'Z drugs' were also associated with an increased fracture risk. An observational study discussed in NICE's eyes on evidence commentary on benzodiazepines and the risk of dementia suggested that benzodiazepines and 'Z drugs' (zolpidem and zopiclone) are associated with an increased risk of dementia. A case-control study discussed in NICE's medicines evidence commentary on benzodiazepine use and risk of Alzheimer's disease found that past benzodiazepine use was associated with an increased

2015 National Institute for Health and Clinical Excellence - Advice

158. Clinical Practice Guidelines on Chronic Obstructive Pulmonary Disease

of COPD 1 Patients who are older than 40 years of age and who are current or ex-smokers should undertake spirometry if they answer yes to any one of the following questions: ? Do you cough regularly? ? Do you cough up phlegm regularly? ? Do even simple chores or light exertion make you short of breath? ? Do you wheeze when you exert yourself, or at night? ? Do you get frequent “colds” that persist longer than those of other people you know? GPP 20 Utility of spirometry 2 All patients who are suspected (...) . The presence of a post-bronchodilator FEV 1/FVC ratio 40 years of age with a history of smoking should be assessed on a yearly basis for symptoms of COPD i.e. dyspnoea, chronic cough or chronic sputum production. GPP D Patients with any symptoms of COPD (i.e. dyspnoea, chronic cough or chronic sputum production) should undergo a spirometry to assess for the presence of COPD. 80 Grade D, Level 4 7.2.2 Screening in the general population D Screening spirometry in the general asymptomatic population

2017 Ministry of Health, Singapore

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