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Neurogenic Shock

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101. Gastrointestinal Complications (PDQ®): Health Professional Version

to manage chronic neurogenic and anatomic colonic dysmotility resulting in chronic constipation or fecal incontinence.[ ] Several studies have found greater efficacy with TAI than with conventional management strategies for neurogenic bowel dysfunction;[ - ] however, no studies have shown either safety or efficacy in people with constipation related directly to a tumor or caused by treatment for cancer or side-effect management (e.g., opioid-induced constipation). Complications, although rare (...) in the currently indicated populations, include bowel perforation.[ , ] Colon cancer, history of any colorectal surgery, and pelvic radiation are considered relative or absolute contraindications to using TAI.[ ] At this time, for patients with cancer or a history of cancer, the evidence does not support the use of TAI for management of chronic constipation or fecal incontinence for conditions other than neurogenic dysfunction. Medical Agents for Constipation Bulk producers Bulk producers are natural

2018 PDQ - NCI's Comprehensive Cancer Database

103. Surgical Management of Stones: AUA/Endourology Society Guideline

ultrasound [US], 188 KUB, 156 intravenous pyelogram [IVP], 68 complete blood count [CBC], 29 stone analysis and 112 urine culture) did not report the purpose of performing these tests. There were no reliable data on the utility or incremental value of testing. The procedures of interest were percutaneous nephrolithotomy (PCNL), ureteroscopy (URS), laparoscopy, shock-wave lithotripsy (SWL), open surgery, robotic surgery, ureteral stent, or nephrostomy. Comparison of any of these active treatments against

2016 American Urological Association

104. Clinical Practice Guidelines for The Management of Candidiasis

of fever and should be based on clinical assessment of risk factors, surrogate markers for invasive candidiasis, and/or culture data from nonsterile sites (strong recommendation; moderate-quality evidence). Empiric antifungal therapy should be started as soon as possible in patients who have the above risk factors and who have clinical signs of septic shock (strong recommendation; moderate-quality evidence) . 29. Preferred empiric therapy for suspected candidiasis in nonneutropenic patients (...) of candidiasis, candidemia and invasive candidiasis have been given the most attention in clinical trials. Candidemia is associated with up to 47% attributable mortality [ ], and this is even higher among persons with septic shock [ ]. Several authors have demonstrated that mortality is closely linked to both timing of therapy and/or source control [ ]. That is, earlier intervention with appropriate antifungal therapy and removal of a contaminated central venous catheter (CVC) or drainage of infected

2016 Infectious Diseases Society of America

106. CRACKCast E038 – Pediatric Trauma

above T1: lower extremity findings of SCI: flaccid paralysis of skeletal and smooth muscle leading to hypovolemia due to decreased SVR resolves in hours to day(s) Neurogenic shock injury above T6 loss of sympathetic tone and have UNOPPOSED parasympathetic tone: hypotension and bradycardia treatment: atropine, ino-pressors, fluids are used backboards should be removed ASAP: only use is for extraction 14) How can you discern between true subluxation and pseudosubluxation at C2/C3 Pseudosubluxation (...) in Perspective: Compared to adults, kids have: proportionally larger abdominal organs less subcutaneous fat less protective abdominal muscles proportionally larger kidneys flexible cartilaginous ribs that can compress internal organs without showing fractures Diagnosis can be more difficult: very difficult to obtain complete history physical exam is plagued with difficulty tachypnea abdominal tenderness / bruising shock shoulder pain vomiting (late sign in child with duodenal hematoma or pancreatic injury

2016 CandiEM

107. CRACKCast E044 – Neck Trauma

: CT head and neck CTA – neck Comatose patients need intubation and ventilation – with PEEP due to pulmonary edema or ARDS ****initial GCS is NOT predictive of outcome*** Prevent secondary neurologic injury MISC other injuries not covered on the podcast: Neurological injury: Be aware of the brachial plexus and peripheral nerve roots Cervical sympathetic chain, cranial nerves VII, IX, X, XI and XII Spinal cord Complete cord injury results in paraplegia, neurogenic shock, bradycardia, hypotension (...) are the indications for immediate OR vs CTA in managing penetrating neck trauma? Most injuries have nonspecific signs/symptoms: serial examination is key Presence of soft signs suggests non-vascular injury, but 5-15% may still have a vascular injury Features of decompensation: Dyspnea Dysphonia Stridor Drooling Expanding hematoma Bruit Cerebral ischemia Shock “HARD SIGNS” – very high likelihood of vascular injury Expanding Hematoma Arterial bleed Roaring bruit Neurologic Deficits Stridor Ischemia No radial

2016 CandiEM

108. CRACKCast E043 – Spinal Injuries

methylprednisolone then infusion @ 5.4mg / kg/hr. Variable length of infusion 14) For whom is surgical intervention indicated immediately with a spinal cord injury Impingement on spinal cord by foreign bodies, herniated disks, bony fracture fragments or epidural hematoma 15) Define neurogenic shock and describe its management I prefer neurogenic hypotension (newest version of Rosen’s uses this). In contradistinction to spinal shock (see above), neurogenic hypotension is loss of vasomotor tone and lack of reflex (...) the presence of spinal shock? What is spinal shock? Clinical syndrome characterized by temporary loss of neurologic function and autonomic tone below lesion. Lasts 24 hours to 2 weeks, and is heralded by the return of the bulbocavernosus reflex. 9) List features of sacral sparing Perianal sensation Rectal motor function Great toe flexor activity 10) List Dermatomes/ Myotomes / Spinal reflexes 11) List 6 causes of Horner’s Syndrome MS Encephalitis Tumours Lateral medullary syndrome Thyroid masses or removal

2016 CandiEM

109. CRACKCast E009 – Adult Resuscitation

(less likely) 75% of the time due to CAD (30% due to acute MI) other possible causes: hypertrophic cardiomyopathy structural disease (valves) deterioration to PEA/asystole after defibrillation Respiratory usually progresses: hypertension > tachychardia > hypotension > bradycadia > PEA/VT/asystole foreign body / asthma / tension pneumothorax / PE / pneumosepsi Circulatory/Obstructive tension pneumothorax / cardiac tamponade / PE hemorrhage, sepsis, neurogenic shock Metabolic hyperkalemia hyper/hypoMg (...) /hypokalemia – rare Toxic Digoxin / CCB TCAs Cocaine / Heroin / CO / monoxide Environmental electrocution 100 mA = can cause VF if reach heart >2000mA = asystole and apnea (*reverse triage at lightning strikes) hypothermia: requires external and internal rewarming allow for prolonged resuscitation drowning results in bradycardic arrest Alternatively you can just go through all the causes of shock. 2) List the two most important determinants of good outcomes in cardiac arrest? TWO most important

2016 CandiEM

110. WHO guidelines on the management of health complications from female genital mutilation

of violence against girls and women, and a practice that sustains unequal gender norms and stereotypes that contravene human rights. Human rights treaty monitoring bodies have consistently made clear that harmful practices like FGM 6 WHO guidelines on the management of health complications from female genital mutilation Box 1.2: Health risks of FGM Risk Remarks IMMEDIATE RISKS (6, 8) Haemorrhage Pain Shock Haemorrhagic, neurogenic or septic Genital tissue swelling Due to inflammatory response or local

2016 World Health Organisation Guidelines

113. Urolithiasis

urography (MRU) 14 3.4 Disease management 14 3.4.1 Management of patients with renal or ureteral stones 14 3.4.1.1 Renal colic 15 3.4.1.2 Management of sepsis in obstructed kidney 15 3.4.2 Specific stone management in Renal stones 16 3.4.2.1 Types of treatments 16 3.4.2.1.1 Conservative treatment (Observation) 16 3.4.2.1.2 Pharmacological treatment 16 3.4.2.1.2.1 Percutaneous irrigation chemolysis 16 3.4.2.1.2.2 Oral chemolysis 16 3.4.2.1.3 Extracorporeal shock wave lithotripsy (SWL) 17 3.4.2.1.3.1 (...) Contraindications of extracorporeal shock wave lithotripsy 17 3.4.2.1.3.2 Best clinical practice 17 3.4.2.1.3.3 Complications of extracorporeal shock wave lithotripsy 18 3.4.2.1.4 Endourology techniques for renal stone removal 19 3.4.2.1.4.1 Percutaneous nephrolithotomy (PNL) 19UROLITHIASIS - LIMITED UPDATE MARCH 2015 3 3.4.2.1.4.1.1 Contraindications 19 3.4.2.1.4.1.2 Best clinical practice 19 3.4.2.1.4.1.3 Complications 20 3.4.2.1.4.2 Ureterorenoscopy for renal stones (RIRS) 21 3.4.2.1.4.3 Open

2015 European Association of Urology

114. Paediatric Urology

systems 34 3J.3 Diagnostic evaluation 34 3J.4 Disease management 34 3J.4.1 Supportive treatment measures 34 3J.4.2 Alarm treatment 34 3J.4.3 Medication 34 3K MANAGEMENT OF NEUROGENIC BLADDER IN CHILDREN 36 3K.1 Epidemiology, aetiology and pathophysiology 36 3K.2 Classification systems 36 3K.3 Diagnostic evaluation 37 3K.3.1 Urodynamic studies 37 3K.3.1.1 Method of urodynamic study 374 PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2015 3K.3.1.2 Uroflowmetry 37 3K.3.2 Cystometry 37 3K.4 Disease management (...) Disease management 55 3N.4.1 Extracorporeal shock wave lithotripsy 55 3N.4.2 Percutaneous nephrolithotomy 56 3N.4.3 Ureterorenoscopy 57PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2015 5 3N.4.4 Open or laparoscopic stone surgery 57 3N.5 Conclusions and recommendations 58 3O OBSTRUCTIVE PATHOLOGY OF RENAL DUPLICATION: URETEROCELE AND ECTOPIC URETER 59 3O.1 Epidemiology, aetiology and pathophysiology 59 3O.1.1 Ureterocele 59 3O.1.2 Ectopic ureter 59 3O.2 Classification systems 59 3O.2.1 Ureterocele 59 3O

2015 European Association of Urology

115. Male Sexual Dysfunction

LUTS and sexual dysfunction in > 12,000 men aged 50-80 years. Of 83% men self- reported to be sexually-active, the overall prevalence of LUTS was 90%, with an overall prevalence of ED of 49%, and a reported complete absence of erection in 10% of patients. Moreover, the overall prevalence of ejaculation disorders was 46% [29]. 3A.1.3 Pathophysiology The pathophysiology of ED may be vasculogenic, neurogenic, anatomical, hormonal, drug-induced and/or psychogenic (Table 1) [11].6 MALE SEXUAL (...) DYSFUNCTION - UPDATE MARCH 2015 Table 1: Pathophysiology of ED Vasculogenic - Cardiovascular disease (hypertension, coronary artery disease, peripheral vasculopathy, etc.) - Diabetes mellitus - Hyperlipidaemia - Smoking - Major pelvic surgery (RP) or radiotherapy (pelvis or retroperitoneum) Neurogenic Central causes - Degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy, etc.) - Spinal cord trauma or diseases - Stroke - Central nervous system tumours Peripheral causes - Type 1

2015 European Association of Urology

116. Urological Infections

prophylaxis by procedure 54 3N.4.1 Diagnostic procedures 54 3N.4.1.1 Transrectal prostate biopsy 54 3N.4.1.2 Cystoscopy 54 3N.4.2 Endourological treatment procedures (urinary tract entered) 54 3N.4.2.1 TUR-BT 54 3N.4.2.2 TUR-P 54 3N.4.2.3 Ureteroscopy 54 3N.4.2.4 Percutaneous nephrolithotripsy 55 3N.4.2.5 Shock-wave lithotripsy 55 3N.4.3 Laparoscopic surgery 55 3N.4.4 Open or laparoscopic urological operations without opening of the urinary or genital tracts (clean procedures) 55 3N.4.5 Open (...) immunosuppression* - Connective tissue diseases* - Prematurity, new-born N Nephropathic disease, with risk of more severe outcome - Relevant renal insufficiency* - Polycystic nephropathy U Urological RF , with risk of more severe outcome, which can be resolved during therapy - Ureteral obstruction (i.e. stone, stricture) - Transient short-term urinary tract catheter - Asymptomatic Bacteriuria** - Controlled neurogenic bladder dysfunction - Urological surgery C Permanent urinary Catheter and non-resolvable

2015 European Association of Urology

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