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Emergency Medicine Pitfalls

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81. Developing a Value Framework for Genetic Diagnosis: Part I A Systematic Review of Outcomes Hierarchies and Measurement Approaches

Coronary artery disease CBA Cost-benefit analysis CEA Cost-effectiveness analysis CGS Clinical genetic services CUA Cost-utility analysis EMR Electronic medical records EU European Union EGAPP Evaluation of Genomic Applications in Practice and Prevention HbA 1 c Hemoglobin A 1 c HRQL Health-related quality of life IOM Institute of Medicine NICE United Kingdom (UK) National Institute for Health and Clinical Excellence NIH National Institutes of Health (DHHS) NQMC National Quality Measures Clearinghouse (...) guidelines ”on the effectiveness and appropriate use of health services. 1 In 1990, the Institute of Medicine (IOM) defined quality in health care as: “..the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” 2,3 This definition was reaffirmed in 2001 in a report from the IOM Committee on Quality of Health Care entitled Crossing the Quality Chasm: A new health system for the 21 st

2019 American College of Medical Genetics and Genomics

82. ACR–ASNR–SPR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Head and Neck

, or advances in knowledge or technology subsequent to publication of this document. However, a practitioner who employs an approach substantially different from the guidance in this document is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible (...) , contraindications to magnetic field exposure (see section V below), artifacts from metallic objects in the head and neck, and long scan times relative to CT for emergent indications. CT may be a better option than MRI if there are patient limitations such as significant claustrophobia, altered mentation, or an underlying medical condition such as congestive heart failure or a breathing disorder that makes lying flat difficult. CT may also be the procedure of choice for evaluating neck lesions associated

2019 American Society of Neuroradiology

83. Canadian stroke best practice recommendations: telestroke best practice guidelines update

to telecommunications in remote areas,fragmentation of care), theevidence-to-date sets the foundation for improving access to care and management for patients during both the acute phase and now through post stroke recovery. 1 Department of Neurology, Saint John Regional Hospital, New Brunswick, Canada 2 Faculty of Medicine, Dalhousie University, Nova Scotia, Canada 3 Heart and Stroke Foundation, Toronto, Ontario, Canada 4 Workhorse Consulting, London, Ontario, Canada 5 Western University, London, Ontario, Canada 6 (...) University Hospital, Edmonton, Alberta, Canada 7 Manitoba Health, Winnipeg, Manitoba, Canada 8 CHU de Que ´bec—Universite ´ Laval, Que ´bec, Canada 9 Department of Health, Charlottetown, Prince Edward Island, Canada 10 Health Sciences Centre, St. John’s, Newfoundland and Labrador, Canada 11 Resau Universitaire de Sante McGill University, Montreal, Quebec, Canada 12 Island Health, British Columbia, Canada 13 Department of Medicine, Division of Neurology, Neurology and Neurocritical Care, University

2017 CPG Infobase

84. Cutaneous melanoma

Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation. KEY TO EVIDENCE STATEMENTS AND RECOMMENDATIONS LEVELS OF EVIDENCE 1 ++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2 ++ High-quality systematic reviews of case-control or cohort studies (...) and artificial sunlight. 1 Although melanoma is the major cause of skin cancer mortality it is often curable by surgery if recognised and treated at an early stage. In recent years considerable efforts have been made to increase public and professional awareness of melanoma in order to promote early detection. In contrast, prognosis for patients with advanced melanoma remains poor although considerable progress has been made with the emergence of molecular therapies including BRAF inhibitors and novel

2017 SIGN

85. Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews

, Burchett H, Stansfield C, Brunton G, Sutcliffe K, Thomas J January 2019viii The authors of this report are: Dickson K 1 , Richardson M 1 , Kwan I 1 , MacDowall W 2 , Burchett H 2 , Stansfield C 1 , Brunton G 1 , Sutcliffe K 1, Thomas J 1 1 – EPPI-Centre, UCL Institute of Education, University College London, London, UK 2 – London School of Hygiene and Tropical Medicine, London, UK Acknowledgements Funding This report is independent research commissioned by the National Institute for Health Research (...) process. Meetings were held between the EPPI-Centre and the Chief Medical Officer and DHSC policy analysts to ensure the review remained closely aligned with their needs and emerging policy requirements. 2.2 Study identification Searches of 12 bibliographic databases that contain research literature on mental health, healthcare, social science and education were carried out in August 2018. We also searched six other online resources. Systematic reviews were also identified from title and abstract

2018 EPPI Centre

86. Emergency contraception

Medicine . 11 : 19–24. Archived from on 2006-11-02 . Retrieved 2006-12-02 . . The Emergency Contraception Website . Office of Population Research at and the . November 2006 . Retrieved 2006-12-02 . Committee on Adolescence (December 2012). . Pediatrics . 130 (6): 1174–1182. : . . Retrieved December 23, 2013 . Gold, Melanie A.; Wolford, Jennifer E.; Smith, Kym A.; Parker, Andrew M. (April 2004). "The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive (...) : A neglected preventive health measure". American Journal of Preventive Medicine . 19 (4): 228–229. : . . ^ Speroff, Leon; Darney, Philip D. (2011). "Special uses of oral contraception: emergency contraception, the progestin-only minipill". A clinical guide for contraception (5th ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 153–166. . p. 155: Emergency postcoital contraception Levonorgestrel Mechanism and efficacy There is strong evidence that treatment with emergency contraception acts primarily

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2012 Wikipedia

87. Homelessness at Transition

homelessness service 8 HOMELESSNESS AT TRANSITION | SAX INSTITUTE Executive summary Background People leaving government-funded services have an elevated risk of becoming homeless. This includes people with a history of out-of-home care, people who have been involved with the justice system or hospitalised because of a mental illness, and frequent users of hospital emergency departments. However, not everyone who has these experiences also goes on to experience homelessness. This review is interested (...) facilities, and mental illness requiring hospitalisation. Homeless people have also been found to be over-represented among chronic users of emergency departments and commonly, they have had failed tenancies in both the private and social housing sectors. However, not all people with these histories experience homelessness. This Evidence Check aims to synthesise the knowledge about ‘who’ among these at-risk populations is likely to become homeless and the type of models or interventions shown

2017 Sax Institute Evidence Check

90. Informing best practice in the conduct of a Root Cause Analysis: A literature review

[11,12]. Eleven documents were in healthcare settings and one document was in the aviation setting. Best practice features of an RCA and tools used to facilitate an RCA From the literature included in our report the following details emerged: Content • There are no standardised methods in the RCA process, and the process varied from 6-11 steps. • Regardless of the number of steps in the RCA process, the main objectives were always to understand what happened, identify the root cause of failure (...) for conducting an RCA and evaluations of RCA training programmes. This did not encompass the appropriate selection and/or application of various tools and techniques to facilitate an RCA, or address the limitations or pitfalls to conducting an RCA. Conclusion This review sought to report on what best practice features of an RCA include and to provide examples of tools used to facilitate an RCA. To this end the literature describes methods of conducting RCA are fraught with inconsistencies and subject

2017 Monash Health Evidence Reviews

91. CRACKCast Episode 149 – Aspirin and Nonsteroidal Agents

Correct potassium depletion Consider activated charcoal (AC) Alkalinize urine Initiate hemodialysis Administer IV dextrose for any CNS abnormalities Pearls & Pitfalls as per Pearls Optimize electrolyte imbalances prior to intubation, correct hypokalemia to >4 mEq/L If intubation necessary, give bicarb boluses (2 mEq/kg IV) and maintain vent settings at PRE-INTUBATION respiratory status, i.e. high minute ventilation and PCO2 < 20 mmHg. YOU CAN KILL A SALICYLATE TOXICITY PATIENT WITH INCORRECT (...) VENTILATOR SETTINGS! Early hemodialysis Serial salicylate levels and VBGs q 2 hours Serum alkalinization more important than urine Avoid acidemia! Pitfalls Forced diuresis with large volume IVF has no proven benefits, increased risk of pulmonary edema in patients already at risk for this Hyperventilation/tachypnea itself is not an indication for intubation à It is often a compensatory mechanism for the metabolic acidosis Overreliance on serum salicylate levels Not correcting hypokalemia Inadequate serum

2018 CandiEM

92. Non-medical Prescription Stimulant Use among Post-secondary Students

stimulants, for example Ritalin® (methylphenidate) or Adderall® (amphetamine), are often used to treat attention deficit hyperactivity disorder (ADHD) (Canadian Centre on Substance Abuse, 2016a). Prescription stimulants used as prescribed can be of significant benefit to those who need them. However, the inappropriate use of these drugs can lead to significant harm, and is of particular concern with respect to emerging adults, aged 18–25 (Lakhan & Kirchgessner, 2012; McCabe, Knight, Teter, & Wechsler (...) vary substantially, but are significantly higher than the general emerging adult population. Among Canadian post-secondary students past-year prevalence use is approximately 4–6%. ? Post-secondary students who perceive prescription stimulants as less harmful are more likely to report non-medical use. ? The most common reported motivation for non-medical prescription stimulant use among post-secondary students is for academic enhancement, despite research to suggest that those who do use

2018 Canadian Centre on Substance Abuse

93. Tubal Ectopic Pregnancy

is a medical emergency that requires prompt surgical intervention. The purpose of this document is to review information on the current understanding of tubal ectopic pregnancy and to provide guidelines for timely diagnosis and management that are consistent with the best available scientific evidence. Background Epidemiology According to the Centers for Disease Control and Prevention, ectopic pregnancy accounts for approximately 2% of all reported pregnancies ( ). However, the true current incidence (...) of hemorrhage-related mortality ( ). The prevalence of ectopic pregnancy among women presenting to an emergency department with first-trimester vaginal bleeding, or abdominal pain, or both, has been reported to be as high as 18% ( ). Etiology The fallopian tube is the most common location of ectopic implantation, accounting for more than 90% of cases ( ). However, implantation in the abdomen (1%), cervix (1%), ovary (1–3%), and cesarean scar (1–3%) can occur and often results in greater morbidity because

2018 American College of Obstetricians and Gynecologists

94. Blood & Clots Series: Does my complex patient have DIC?

patients: PTT confounding and other pitfalls. Expert Opin Drug Saf . 2014;13(1):25-43. [ ] 3. Warkentin T, Heddle N. Laboratory diagnosis of immune heparin-induced thrombocytopenia. Curr Hematol Rep . 2003;2(2):148-157. [ ] (Visited 906 times, 1 visits today) Andrew Shih Dr. Andrew Shih works as a Transfusion Medicine specialist at Vancouver Coastal Health Authority. His interests include education regarding the safety and appropriate utilization of blood products and advance blood transfusion (...) support. DIC with Bleeding Being Predominant Red Blood Cell Transfusions One unit at a time with a restrictive threshold (<70-80 g/L) if possible Frozen Plasma (10-15cc/kg; often 3-4 units) Only when clinical bleeding and/or urgent/emergent surgery is occurring AND INR > 1.7 Patients with increased INR and no bleeding should not receive plasma Platelets (1 adult dose; each dose typically increases platelet count by 15-30 x 10 9 /L – but may be lower with platelet consumption in DIC) Likely indicated

2018 CandiEM

95. Exam Series: Guide to the Knee Exam

for ligamentous and meniscal injuries. Reserve Zimmer splints for patients with patellar dislocations, patellar tendon or quadriceps tears. Additional Resources : MSK Clinical Skills Manuals and Instructional Videos : Quick reference orthopedic information : Youtube videos for clinical assessment : Episode 91 Occult Knee Injuries Pearls and Pitfalls This post was copyedited by Brad Stebner ( ) References: 1. Pallin D. Knee and Lower Leg. In: Rosen’s Emergency Medicine . 9th ed. Philadelphia: Elsevier; 2018 (...) completed her Emergency Medicine residency and also a Fellowship in Sports and Exercise Medicine at McMaster University. She is currently an Emergency Physician at Hamilton Health Sciences and is the team physician for the varsity rugby teams at McMaster University. (Visited 2,395 times, 10 visits today) Kathryn Chan Dr. Kathryn Chan is an emergency medicine resident at McMaster University and a former biomedical engineer. Her interests include medical technologies, systems thinking, and social

2018 CandiEM

96. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

Chitra Ravishankar, MD Ricardo A. Samson, MD Ravi R. Thiagarajan, MBBS, MPH Rune Toms, MD James Tweddell, MD, FAHA Peter C. Laussen, MBBS, Co-Chair On behalf of the American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardio- vascular Surgery and Anesthe- sia; and Emergency Cardiovas- cular Care Committee Cardiopulmonary Resuscitation in Infants (...) , there appears to be no benefit from routine use of the angiotensin-converting enzyme inhibitor enalapril. 64 The risk of high Qp:Qs is present with both the RVPAS and the MBTS. 65 If the patient with deteriorating SBF caused by a large or inadequately restrictive shunt is not responsive to medical management, consider emergent shunt revision or stabilization with ECLS. Dis- tal arch obstruction will mimic elevated SVR by increas- ing Qp:Qs, especially in those patients with an MBTS; even mild arch

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2018 American Heart Association

97. Wellness Criteria for P.E. (Practice Enjoyment)

Wellness Criteria for P.E. (Practice Enjoyment) Wellness Criteria for P.E. (Practice Enjoyment) - CanadiEM Wellness Criteria for P.E. (Practice Enjoyment) In by Gerhard Dashi March 16, 2018 Editors Note: As part of emergency medicine’s annual wellness week (#iEMWell18), Dr. Gerhard Dashi riffed off of the well known Well’s Criteria for Pulmonary Embolism to create the Wellness Criteria for Practice Enjoyment! Score yourself using our infographic to determine how likely it is that you (...) Criteria has been criticized as “fake news”, “extremely subjective”, and “not validated”. These are extremely valid points. The Wellness Criteria is not meant to diagnose P.E. (practice enjoyment), but to be used as a tool by programs and residents during EM Wellness Week 2018. A PDF version of the Infographic can be downloaded . (Visited 542 times, 1 visits today) Gerhard Dashi Gerhard Dashi is an Emergency Medicine at the University of Toronto. Having just read “Kitchen Confidential”, he now self

2018 CandiEM

98. Trauma blunt

where present ​​​​​​​May require hospital admission Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation ( ) Sources of evidence Alteveer J, Lahmann B. An evidence-based approach to traumatic ocular emergencies. Emergency Medicine Practice 2010;12(5):1-21 Betts T, Ahmed S, Maguire S, Watts P. Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review. Eye (Lond). 2017;31(8):1146-54 Kuhn F, Morris R, Witherspoon CD, Mester V (...) =low, Strength of recommendation=strong) In cases of corneal abrasion consider topical antibiotic (GRADE*: Level of evidence=low, Strength of recommendation=weak) Management category Management depends on severity of injury Mild cases: B2: alleviation or palliation; referral unnecessary Severe cases: A2: first aid measures and emergency (same day) referral to A&E Possible management by ophthalmologist Assessment and investigation including imaging (e.g. X-ray, CT, MRI) Treatment of globe rupture

2018 College of Optometrists

99. Imaging of Mesenteric Ischemia

MM, Liu PS, Platt JF. Multidetector CT imaging in mesenteric ischemia-- pearls and pitfalls. Emerg Radiol. 2011;18(2):145-156. 33. Hagspiel KD, Flors L, Hanley M, Norton PT. Computed tomography angiography and magnetic resonance angiography imaging of the mesenteric vasculature. Tech Vasc Interv Radiol. 2015;18(1):2-13. 34. Klar E, Rahmanian PB, Bucker A, Hauenstein K, Jauch KW, Luther B. Acute mesenteric ischemia: a vascular emergency. Dtsch Arztebl Int. 2012;109(14):249-256. 35. Ofer A, Abadi S (...) University Medical Center, Maywood, Illinois. c University of Virginia Health System, Charlottesville, Virginia. d Panel Chair (Vascular), University of Virginia Health System, Charlottesville, Virginia. e Panel Vice-Chair (Vascular), Brigham & Women’s Hospital, Boston, Massachusetts. f The University of South Florida Morsani College of Medicine, Tampa, Florida. g Scripps Green Hospital, La Jolla, California; Society for Vascular Surgery. h Newton-Wellesley Hospital, Newton, Massachusetts. i H. Lee

2018 American College of Radiology

100. Testosterone Therapy in Men with Hypogonadism

-mail: . Reprint requests should be sent to The Endocrine Society, 2055 L Street NW, Suite 600, Washington, DC 20036. E-mail: ; Phone: 202-971-3636. Search for other works by this author on: Juan P Brito Mayo Clinic, Rochester, Minnesota Search for other works by this author on: Glenn R Cunningham Baylor College of Medicine, Houston, Texas Search for other works by this author on: Frances J Hayes Massachusetts General Hospital, Boston, Massachusetts Search for other works by this author on: Howard N (...) Hodis Keck School of Medicine, University of Southern California, Los Angeles, California Search for other works by this author on: Alvin M Matsumoto Veterans Affairs Puget Sound Health Care System, Seattle, Washington Search for other works by this author on: Peter J Snyder Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Search for other works by this author on: Ronald S Swerdloff Harbor–UCLA Medical Center, Torrance, California Search for other works

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2018 The Endocrine Society

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