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High Pressure Injection Wound

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181. Management of Opioid Therapy (OT) for Chronic Pain

, substance use disorders, and/or mental health problems for patients presenting with high risk and/or aberrant behavior. Strong for Reviewed, New- replaced 17. We recommend offering medication assisted treatment for opioid use disorder to patients with chronic pain and opioid use disorder. Note: See the VA/DoD Clinical Practice Guideline for the Management of Substance Use Disorders. Strong for Reviewed, New- replaced Opioid Therapy for Acute Pain 18. a) We recommend alternatives to opioids for mild (...) for “fun” or to “get high,” while 22% used the medication to relieve day-to-day stress.[18] Concurrent with the increase in prescription opioid use, the rate of heroin overdose deaths increased nearly four-fold between 2000 and 2013.[19] According to a survey of patients entering SUD treatment for heroin use, the prescription opioid epidemic has resulted in a marked shift in how and which opioids are abused. In the 1960s, 80% of people entering treatment for heroin use started using heroin

2017 VA/DoD Clinical Practice Guidelines

182. Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association

was utilized to determine the rating. Table 1. Quality Rating Scale for Individual Articles , Level >Criteria I Evidence obtained from high-quality diagnostic studies, prognostic or prospective studies, cohort studies or randomized controlled trials, meta-analyses or systematic reviews; critical appraisal score >50% II Evidence obtained from lesser-quality diagnostic studies, prognostic or prospective studies, cohort studies or randomized controlled trials, meta-analyses or systematic reviews (eg, weaker (...) diagnostic criteria and reference standards, improper randomization, no blinding, <80% follow-up); critical appraisal score ≤50% III Case-controlled studies, retrospective studies, or studies of only healthy control subjects Level >Criteria I Evidence obtained from high-quality diagnostic studies, prognostic or prospective studies, cohort studies or randomized controlled trials, meta-analyses or systematic reviews; critical appraisal score >50% II Evidence obtained from lesser-quality diagnostic studies

2017 American Physical Therapy Association

183. Peripheral venous cannulation of children

for this (floating, two-handed, one-step and pushing off the stylet). These are described in full in (PDF) . Individual HCPs will discover their preferred technique through experience ( ; ). Release the tourniquet ( ). Taking care to hold the cannula in position to avoid extravasation, position a piece of clean cotton wool or gauze beneath the end of the cannula hub to absorb any blood that may escape. Remove the stylet while applying digital pressure over the cannula with one finger ( ). Place the stylet safely (...) in the tray, ensuring it is not allowed to contaminate clean unused materials ( ). Continuing to protect the cannula, connect a T-extension using ANTT and flush with 1–2ml of 0.9% normal saline, using a 10ml syringe ( ; ; )( ). Clamp the T extension whilst still flushing using a pulsating push pause technique to create turbulent flow and positive pressure ( ; )( ). Remove the syringe and apply a needless port (eg Microclave ® ) to the end of the T-extension. The HCP is responsible for the safe disposal

2017 Publication 1593

184. The Diagnosis and Acute Management of Childhood Stroke, Clinical Guideline

risk of in- hospital death if the child experienced high blood pressure (141). However, in this study, the method and timing of measurements were not controlled, and due to diagnostic delays, some measures may have been taken up to five days post stroke. In contrast, Grelli et al respectively analysed 98 children diagnosed with arterial ischaemic stroke and concluded that hypertension was not associated with infarct size, poor clinical outcome or mortality (142). This cohort was notably different (...) -65 80-100/40-65 SBP, systolic blood pressure; DBP, diastolic blood pressure; * blood pressure ranging from 5th - 95th percentile of height. The 90th percentile blood pressure is 1.28 standard deviations over the mean. Adapted from the fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents (135) and the guidelines for basic paediatric neurological observation (146).Australian Childhood Stroke Advisory Committee 25 8.2 Glucose Both hyper

2017 Stroke Foundation - Australia

185. Endocrine Society of Australia position statement on male hypogonadism (part 2): treatment and therapeutic considerations

of older men without pathological hypogonadism who were given testosterone treatment. Additional studies are needed to clarify whether testosterone therapy influences cardiovascular risk. Testosterone is the native hormone that should be replaced in men being treated for pathological hypogonadism. Convenient and cost-effective treatment modalities include depot intramuscular injection and transdermal administration (gel, cream or liquid formulations). Monitoring of testosterone therapy is recommended (...) passing urine, muscle pain, priapism and increased blood pressure. Refer to prescribing information for further details of formulation-specific side effects. Monitoring of testosterone therapy Efficacy The best clinical measure of adequate restoration of androgen status is identification and monitoring of the man’s leading symptom. These clinical features are highly variable between men but highly reproducible within any man and distinctive to that individual. Timing of hormone sampling relative

2016 MJA Clinical Guidelines

186. Ankle and Foot Surgical Guideline

-related ankle injury Catching AND/OR Locking AND/OR Effusion Documented loose body on computed tomography (CT) or magnetic resonance imaging (MRI) Not required Ankle Cheilectomy Bony impingement A discrete documented work-related ankle injury AND Pain Decrease in range of motion (ROM) Plain radiographs demonstrating osteophyte formation on the distal tibia or talus At least 6 weeks of any of the following: Activity modification, Non- opioid analgesics, Steroid injection, Bracing Ankle Arthroplasty (...) analgesics, Bracing, Immobilization, Orthotics, Injections 5 Washington State Department of Labor and Industries Surgical Guideline for Work-related Ankle and Foot Injuries – October 2017 A request may be appropriate for If the patient has AND the diagnosis is supported by these clinical findings: AND this has been done Surgical Procedure Condition or Diagnosis Subjective Objective Imaging Non-operative care Debridement or Stabilization of a Medial Lesion of the Talus Osteochondral defect of the talus

2017 Washington State Department of Labor and Industries

187. Management of Cancer Pain in Adult Patients: ESMO Clinical Practice Guidelines

% in patients after cura- tive treatment, to 59% in patients on anticancer treatment and to 64% in patients with metastatic, advanced or terminal disease [2]. Pain has a high prevalence earlier in disease in speci?c can- cer types such as pancreatic (44%) and head and neck cancer (40%) [3]. Increased survival with either life-prolonging treatment or curative treatment results in increased numbers of patients expe- riencing persistent pain due to treatment or disease, or a combin- ation of both [4 (...) 56% to 82.3%. According to a systematic review published in 2014 [7] using the Pain Management Index (PMI) [8], approximately one-third of patients do not receive appropriate analgesia proportional to their pain intensity (PI). High prevalence has also been documented in haematology patients at diagnosis, during therapy and in the last month of life [9]. These data reinforce the recommendation that patients with advanced or metastatic cancer require management within an integrated system

2018 European Society for Medical Oncology

188. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

, the Vascular Society, the Association of British Neurologists and the British Society of Clinical Neurophysiology. Patients with complex regional pain syndrome (CRPS) and their relatives contributed to the development process. Published with:ii © Royal College of Physicians 2018 The Royal College of Physicians The Royal College of Physicians (RCP) plays a leading role in the delivery of high-quality patient care by setting standards of medical practice and promoting clinical excellence. The RCP provides (...) is disproportionate to any inciting event B) The patient has at least one sign in two or more of the categories C) The patient reports at least one symptom in three or more of the categories D) No other diagnosis can better explain the signs and symptoms ? ? ? ? Category Sign (you can see or feel a problem) Symptom (the patient reports a problem) 1 ‘Sensory’ Allodynia (to light touch and/or temperature sensation and/or deep somatic pressure and/or hyperalgesia (to pinprick) ? Hyperesthesia does also qualify

2018 British Society of Rehabilitation Medicine

189. Intrapartum care for healthy women and babies

origin (single episode after 24 weeks of gestation) BMI at booking of 30–35 kg/m 2 Blood pressure of 140 mmHg systolic or 90 mmHg diastolic or more on 2 occasions Clinical or ultrasound suspicion of macrosomia Para 4 or more Recreational drug use Under current outpatient psychiatric care Age over 35 at booking Fetal indications Fetal abnormality Previous gynaecological history Major gynaecological surgery Cone biopsy or large loop excision of the transformation zone Fibroids W Women omen's e 's (...) the antenatal notes (including all antenatal screening results) and discuss these with the woman. Ask her about the length, strength and frequency of her contractions. Ask her about any pain she is experiencing and discuss her options for pain relief. Record her pulse, blood pressure and temperature, and carry out urinalysis. Record if she has had any vaginal loss. Observations of the unborn baby: Ask the woman about the baby's movements in the last 24 hours. Palpate the woman's abdomen to determine

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

190. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease

of recommendation: GP Consensus: 91.4% (SA 54.3%, A 37.1%) The chronicity of IBD means that patients may require multiple endoscopic and radiological investigations. Where possible, imaging modalities that do not involve ionizing radiation should be used: ultrasonography and especially magnetic resonance imaging (MRI) offer high diagnostic accuracy . Computed tomography (CT) is increasingly used to inform and direct management, especially in the emergency setting . A recent meta‐analysis concluded that 11 (...) % of patients with Crohn's disease and 2% of patients with ulcerative colitis received potentially harmful levels of radiation exposure, with patients requiring surgery being at particularly high risk . Modern CT techniques to minimize radiation dose should ideally be employed when CT is required in IBD patients . Where young patients may need multiple investigations over time, particularly with CT, the use of radiation diaries is advisable to minimize radiation exposure and associated radiation‐induced

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2018 Association of Coloproctology of Great Britain and Ireland

191. Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures

practitioner. Although intended to encourage high-quality pa- tient care, adherence to the recommendations in this document cannot guarantee a specific patient outcome. However, struc- tured sedation protocols designed to incorporate these safety ABBREVIATIONS AAP: American Academy of Pediatrics. AAPD: American Academy of Pediatric Dentistry. ASA: American Society of Anesthesiologists. BIS: Bispectral index. CPAP: Continuous positive airway pressure. ECG: Electrocardiography. EEG: Electroencephalogram (...) require specific training and skills. 63,74,215,216 The maintenance of the skills needed to rescue a child with apnea, laryngospasm, and/or airway obstruction include the ability to open the airway, suction secretions, pro- vide continuous positive airway pressure (CPAP), perform successful bag-valve-mask ventilation, insert an oral airway, a nasopharyngeal airway, or a laryngeal mask airway (LMA), and, rarely, perform tracheal intubation. These skills are likely best maintained with frequent

2016 American Academy of Pediatric Dentistry

192. CRACKCast E050 – Orthopedics – Hand Injuries

as to why infections can spread through the bursae. For example the sheath of FPL – runs from thumb tip all the way to radial bursa (as does the little finger). Knavel’s signs Tenderness along course of the flexor tendon Symmetrical swelling of the finger (sausage finger or fusiform swelling) Pain on passive extension semi-flexed posture of the finger 6) What is the management of a high pressure injection? Splint and elevate affected hand Analgesia Tetanus prophylaxis Broad-spectrum antiobiotics Avoid (...) digital blocks (more fluid in a confined space that has had a bunch of junk injected into it at high pressure = iatrogenic compartment syndrome/vascular compromise) Emergent hand surgeon consult – even if the injection site looks benign 7) What are indications for repair of nerve injuries in hand? Involvement of the motor branches of the ulnar or median nerves Digital nerve injuries that are proximal the DIP and: On the radial side of the index finger On the ulnar side of the little finger Either side

2016 CandiEM

193. CRACKCast E049 – General Principles to Orthopedic Injuries

Tetany Post thermal/electrical burn Snakebite Intra-arterial drug injection Nephrotic syndrome 2. Dec. compartment volume post-operative 3. External pressure Comatose drug user Osteomyelitis Due to OPEN fractures = any communication of bone with the outside ANCEF for prevention, add gentamicin for contaminated Avascular necrosis No blood flow, bone dies comminuted/untreated fractures at ^ risk Femoral head Talus Scaphoid Lunate Capitate Complex regional pain syndrome – type 1 “Pain syndrome (...) tissue → compartment pressure keeps increasing! Venous blood flow impaired as capillary pressure is exceeded Arterial blood flow fails (pulses maintained until LATE!) Ischemic necrosis and cell death! Compartment Syndrome Any # or damage in an osseofascial space = can lead to CS: ● Closed OR open # ● Prolonged immobility in certain operative/comatose positions ● Spontaneous injections ● IV injections ● Excessive fracture traction/trauma Pathophysiology: ● Mismatch between a closed, non-expandable

2016 CandiEM

194. CRACKCast E047 – Genitourinary Trauma

to arteriolar vasoconstriction, aldosterone release. (net increase of blood pressure and blood volume) Epidemiology Renal injury – most commonly injured structure in the GU tract. Blunt trauma from MVCs/falls/direct blows to the flank account for 90% of injuries High energy injury damages all the structures that coalesce at the UPJ Penetrating trauma – often leads to nephrectomy Renal vein injuries → much more common than renal artery injury (if artery injured they have reflexive protective vasospasm) Veins (...) urethrography is NOT recommended in the ER Speak with your urologist if you are concerned Digital Rectal Exam (DRE) “A palpably abnormal (high riding) prostate is an insensitive indicator of urethral injury” A DRE still may be worthwhile in the tertiary survey to look for sphincter tone integrity, bones, gross blood, etc. 1) List 6 general indicators of genitourinary trauma? Flank / abdominal / rib / back / pelvic / scrotal pain Worry in cases of pelvic #’s Anyone with pelvic/suprapubic tenderness Urinary

2016 CandiEM

195. Medication impregnated dressings for central venous catheters reduce the number of bloodstream infections, but the quality of the research is low

a year in England acquire a healthcare-associated infection as a result of care within the NHS, at a cost of approximately £1 billion a year. A central venous catheter is a long thin tube that is inserted into a large vein through which central venous pressure can be monitored or fluids, nutrients, blood, and drugs can be given to a patient. They are often used in the short term in intensive care units and acute care wards. Those used for longer terms, such as in people with cancer receiving (...) chemotherapy, are often constructed differently and may be tunnelled under the skin to reduce infection. Their use avoids the need for repeated injections, but their insertion and long-term use carries the risk of infection being introduced into the bloodstream. Dressings or securement devices that hold them in place may have a role in cutting this infection risk. New products are always coming onto the market and it is important that the evidence on what works best remains current. This Cochrane

2018 NIHR Dissemination Centre

196. Portable Compression to Prevent Venous Thromboembolism After Hip and Knee Surgery: The ActiveCare System

pressure that affects the lungs and right side of the heart). 2,3 VTE is a common complication following surgery, and a frequent reason why patients are re-admitted to the hospital. 4,5 Lower limb surgeries such as hip and knee replacements, and hip fracture repair are associated with a particularly high risk for VTE — mainly due to decreased blood flow during and after surgery, and reduced patient mobility during recovery. 3,5,6 However, VTE is largely avoidable with appropriate preventive measures (...) in 2016, assessed a risk-stratification protocol for VTE prevention in patients undergoing unilateral hip or knee replacement or revision surgery. 38 The study included 3,143 patients divided into low-risk (2,222) and high-risk (921) prophylaxis regimen groups. Patients were excluded from the study if they had a history of DVT, PE, or wound healing complications; were undergoing multiple surgeries; were taking immunosuppressant drugs or long-term warfarin; or were receiving kidney dialysis. High-risk

2016 CADTH - Issues in Emerging Health Technologies

197. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

by early surgery. In cases with a high suspicion of IE based on either the clinical picture or the patient’s risk factor profile such as injection drug use, another focus of cardiovascular infection, including catheter-related bloodstream infections caused by S aureus , or a history of previous IE, the presumption of IE often is made before blood culture results are available. Identification of vegetations and incremental valvular insufficiency with echocardiography often completes the diagnostic (...) , mural, infection, diagnosis, bacteremia, case definition, epidemiology, risks, demographics, injection drug use, echocardiography, microbiology, culture-negative, therapy, antibiotic, antifungal, antimicrobial, antimicrobial resistance, adverse drug effects, drug monitoring, outcome, meta-analysis, complications, abscess, heart failure, embolic events, stroke, conduction abnormalities, survival, pathogens, organisms, treatment, surgery, indications, valve replacement, valve repair, ambulatory care

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2016 Infectious Diseases Society of America

198. Guidelines for Laparoscopic Ventral Hernia Repair

when they counsel them about surgical options (High quality evidence, Strong recommendation) Four meta-analyses, including a Cochrane systematic review, have assessed the comparative effectiveness of the laparoscopic and open ventral hernia repair. These studies have examined data from available comparative randomized controlled trials and concluded that there was no difference in recurrence rates or postoperative pain between the techniques, but significantly fewer wound infections occurred after (...) the evidence used to formulate the recommendations included in these guidelines. I. Laparoscopic versus Open Repair Guideline 1: Laparoscopic ventral hernia repair has a lower rate of wound infections compared to open repair. Recurrence rates and post-operative pain are similar between the two techniques during mid-term follow up. The advantages offered by LVHR over open hernia repair in terms of decreased wound complication rates should be taken into consideration by surgeons and disclosed to patients

2016 Society of American Gastrointestinal and Endoscopic Surgeons

199. Clinical Practice Guidelines for The Management of Candidiasis

mg/kg intravenous daily, with or without oral flucytosine, 25 mg/kg 4 times daily is recommended (strong recommendation; low-quality evidence) . 87. With macular involvement, antifungal agents as noted above PLUS intravitreal injection of either AmB deoxycholate, 5–10 µg/0.1 mL sterile water, or voriconazole, 100 µg/0.1 mL sterile water or normal saline, to ensure a prompt high level of antifungal activity is recommended (strong recommendation; low-quality evidence) . 88. The duration (...) process that has been adopted by the Infectious Diseases Society of America (IDSA), which includes a systematic method of grading both the quality of evidence (very low, low, moderate, and high) and the strength of the recommendation (weak or strong) [ ] (Figure ). [ ] The guidelines are not intended to replace clinical judgment in the management of individual patients. A detailed description of the methods, background, and evidence summaries that support each recommendation can be found in the full

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2016 Infectious Diseases Society of America

200. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

, there is a risk of introducing pathogens into a perigraft area with high-pressure instillation of contrast material. Invasive angiography is rarely useful for the diagnosis of VGI. The choice of an imaging modality is best determined by consultation among experts in vascular surgery, infectious diseases, vascular medicine, and radiology. Extracavitary VGI Even when clinical or microbiological findings strongly suggest a VGI, imaging, most often ultrasonography or CTA, is used to support the diagnosis (...) formation can be detected by ultrasonography. Ultrasonography can also identify a subcutaneous or perigraft fluid collection that could be aspirated for analysis, culture, cell count, and other studies used to differentiate a noninfected seroma from bleeding. A sinogram can demonstrate extension of a sinus tract to the graft, which might involve an anastomotic site. A potential risk of sinograms is that an infection can be introduced during the procedure by the high-pressure instillation of contrast

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2016 American Heart Association

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