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Nikolskys Sign

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41. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

Prevention of constipation with stool softeners is encouraged. 4.3.2 Monitoring The general condition of the patient, vital signs, pulse oximetry and the cardiac rhythm should be continuously monitored following STEMI. 4.3 Cardiac Care Unit (CCU) management 4.3.1 General measures All STEMI patients should be admitted to a CCU or equivalent unit equipped with adequate monitoring facilities. Following successful reperfusion, uncomplicated cases may be kept for a minimum of 24 hours before transfer (...) Prevention of constipation with stool softeners is encouraged. 4.3.2 Monitoring The general condition of the patient, vital signs, pulse oximetry and the cardiac rhythm should be continuously monitored following STEMI. 4.3.3 Concomitant therapy 4.3.3.1 Oxygen I, C x Oxygen is indicated in the presence of hypoxaemia (SpO 2 75 years old, 75 years of age and with renal impairment (serum creatinine (Scr) > 200 µmol/L in women and > 250 µmol/L in men), UFH is preferable to LMWH. 128 • Anti Xa inhibitor

2014 Ministry of Health, Malaysia

43. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (Secondary Stroke Prevention)

. These seemingly silent infarctions are associ- ated with typical risk factors for ischemic stroke, increased risk for future ischemic stroke, and unrecognized neurological signs in the absence of symptoms. Clinicians who diagnose silent infarction routinely ask whether this diagnosis war- rants implementation of secondary prevention measures. The writing committee, therefore, identified silent infarction as an important and emerging issue in secondary stroke prevention. Although data to guide management (...) patients are at high risk of having sleep apnea, 272 a sleep study should be considered to identify the presence of sleep apnea among patients with stroke or TIA even in the absence of sleep apnea signs or symptoms. The American Academy of Sleep Medicine recommends the use of polysomnography, either conducted in a sleep laboratory or unattended polysomnography conducted in patients’ homes for the detection of sleep apnea 270 ; however several studies have evaluated the use of autotitrating continuous

2014 Congress of Neurological Surgeons

44. Pemphigoid

on their potential triggering role, such as diuretics. 5,6 1.3.2 Physical examination The physician should search for objective evidence required for diagnosis: • Classical form: severely pruritic bullous dermatosis, with bullae usually arising from erythematous inflamed skin, symmetric distribution (flexural surfaces of the limbs, medial surface of thighs, abdomen), usually without mucosal involvement and atrophic scarring, and negative Nikolsky's sign; 1,2,7,8 • Non-classical/non-bullous forms: pauci-bullous (...) of vesicles and bullae over erythematous and non-erythematous skin(flexural surfaces of the limbs, medial surface of thighs, trunk); rare oral mucosal involvement; no atrophic scarring; no Nikolsky's sign • Non-bullous and atypical forms: excoriations, prurigo, prurigo nodularis-like lesions, localised bullae, erosions, eczematous and urticarial lesions, dyshidrosiform (acral) • Extension of BP (by BPDAI or daily blister count) • General condition and co-morbidities • Laboratory examinations and work-up

2014 European Dermatology Forum

45. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures Full Text available with Trip Pro

; and clinical researchers who have studied PCI outcomes. This writing committee met the College's disclosure requirements for relationships with industry as described in the Preamble. 1.1.2. Document Development and Approval The writing committee convened by conference call and email to finalize the document outline, develop the initial draft, revise the draft per committee feedback, and ultimately, sign off on the document for external peer review. The ACCF, AHA, and SCAI participated in peer review (...) complications such as death, myocardial infarction (MI), stroke, and emergency coronary artery bypass graft (CABG) surgery. The definitionofPCI-related MI has evolved over time, and the currentdefinition is provided below in Section 2.3.2. , Short-term clinical success includes angiographic and procedural success with the subsequent relief of signs and/or symptoms of myocardial ischemia. Long-term clinical success requires that the relief of myocardial ischemia remain durable, persisting for more than 1

2013 American Heart Association

46. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures

convened by conference call and email to finalize the document outline, develop the initial draft, revise the draft per committee feedback, and, ultimately, sign off on the document for external peer review. The ACCF, AHA, and SCAI participated in peer review, resulting in 36 reviewers representing 316 comments. Comments were reviewed and addressed by the writing committee. A member of the ACCF/AHA/ACP Task Force on Clinical Competence and Training served as lead reviewer to ensure that all comments (...) for patients with coronary artery disease. 8. Know the methods to assess functional significance of coronary lesions in the catheterization laboratory. 9. STEMI: know the roles of time of presentation, facility capability, anticipated door-to-device time, presence or absence of ongoing symptoms, and ECG abnormalities on the selection of reperfusion strategy. 10. Know the signs and hemodynamics of cardiac dysfunction, and their impact on reperfusion strategy and PCI decisions. 11. Know the limitations

2013 Society for Cardiovascular Angiography and Interventions

47. 2013 ACC/AHA Guideline for the Management of ST-Elevation Myocardial Infarction - Focused Update

outcomes when treated aggressively with reperfusion therapy (40), though individual circumstances vary. Both the GWTG Quality Improvement Program and the North Carolina Reperfusion of Acute Myocardial Infarction in Carolina Emergency Department’s initiative demonstrated that focused quality improvement efforts and programs de- signed to systematize care across integrated regional centers can lessen disparities and improve the care of elderly patients with STEMI (23,41). Numerous studies have (...) “Act in Time to Heart Attack Signs” campaign (73) stresses that patients can increase their chance of surviving STEMI by learning the warning symptoms, ?lling out a survival plan, and discussing risk reduction with their physician. These materials are available on the National Institutes of Health “Heart Attack” Web page (http://health.nih.gov/topic/HeartAttack/)(74). Healthcare providers should target their educational interven- tions to patients at increased risk for ACS (75). 3.4. Community

2013 Society for Cardiovascular Angiography and Interventions

48. Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians Full Text available with Trip Pro

Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians Treating Anemia in Patients With Heart Disease | Annals of Internal Medicine | American College of Physicians '); } Sign in below to access your subscription for full content INDIVIDUAL SIGN IN | You will be directed to acponline.org to register and create your Annals account INSTITUTIONAL SIGN IN | | Subscribe to Annals of Internal Medicine . You will be directed (...) -than or equal to) 27%) after percutaneous coronary intervention be transfused? JACC 2009 53 A84 Maluenda G , Lemesle G , Syed A , Collins SD , Ben-Dor I , Li Y . et al Does transfusion for major bleeding after percutaneous coronary intervention impact clinical outcome in patients admitted with normal Hematocrit? JACC 2009 53 A72 Nikolsky E , Mehran R , Sadeghi HM , Grines CL , Cox DA , Garcia E . et al Prognostic impact of blood transfusion after primary angioplasty for acute myocardial infarction

2013 American College of Physicians

50. Pemphigus

(neoplastic, cardiovascular, musculoskeletal, diabetes etc.), ? Direct Nikolsky’s sign (type I) in normal appearing skin for monitoring of disease activity: ability to split the epidermis on skin areas distant from the lesions by a lateral pressure with a finger, ? Marginal Nikolsky's sign (type II) in perilesional skin for diagnosis: ability to split the epidermis of the skin far beyond the preexisting erosion, extending to a great distance on 8 the normal-appearing skin, by pulling the remnant (...) (neoplastic, cardiovascular, musculoskeletal, diabetes etc.), ? Direct Nikolsky’s sign (type I) in normal appearing skin for monitoring of disease activity: ability to split the epidermis on skin areas distant from the lesions by a lateral pressure with a finger, ? Marginal Nikolsky's sign (type II) in perilesional skin for diagnosis: ability to split the epidermis of the skin far beyond the preexisting erosion, extending to a great distance on 8 the normal-appearing skin, by pulling the remnant

2013 European Dermatology Forum

51. ST-Elevation Myocardial Infarction: Guideline For the Management of

was increasing age. Evidence suggests that even the very elderly have reasonable post-MI outcomes when treated aggressively with reperfusion therapy (40), though individual circumstances vary. Both the GWTG Quality Improvement Program and the North Carolina Reperfusion of Acute Myocardial Infarction in Carolina Emergency Department’s initiative demonstrated that focused quality improvement efforts and programs de- signed to systematize care across integrated regional centers can lessen disparities (...) of Health “Act in Time to Heart Attack Signs” campaign (73) stresses that patients can increase their chance of surviving STEMI by learning the warning symptoms, ?lling out a survival plan, and discussing risk reduction with their physician. These materials are available on the National Institutes of Health “Heart Attack” Web page (http://health.nih.gov/topic/HeartAttack/)(74). Healthcare providers should target their educational interven- tions to patients at increased risk for ACS (75). 3.4. Community

2012 American College of Cardiology

52. Third Universal Definition of Myocardial Infarction Full Text available with Trip Pro

the infarct-related artery, to estimate the amount of myocardium at risk as well as prognosis, and to determine therapeutic strategy. More profound ST-segment shift or T wave inversion involving multiple leads/territories is associated with a greater degree of myocardial ischaemia and a worse prognosis. Other ECG signs associated with acute myocardial ischaemia include cardiac arrhythmias, intraventricular and atrioventricular conduction delays, and loss of pre-cordial R wave amplitude. Coronary artery (...) in the PR segment, the QRS complex, the ST-segment or the T wave. The earliest manifestations of myocardial ischaemia are typically T wave and ST-segment changes. Increased hyperacute T wave amplitude, with prominent symmetrical T waves in at least two contiguous leads, is an early sign that may precede the elevation of the ST-segment. Transient Q waves may be observed during an episode of acute ischaemia or (rarely) during acute MI with successful reperfusion. lists ST-T wave criteria for the diagnosis

2012 American Heart Association

53. KDIGO Clinical Practice Guideline for Acute Kidney Injury

KidneyDisease:Improving GlobalOutcomes (KDIGO) makes everyeffort to avoid any actual or reasonably perceived con?icts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the Work Group. All members of the Work Group are required to complete, sign, and submit a disclosure and attestation form showing all such relationships that might be perceived or actual con?icts of interest. This documentisupdatedannually andinformation

2012 National Kidney Foundation

54. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update

draft, revise the draft per committee feedback, and ultimately sign off on the document for external peer review. All participating organizations participated in peer review, resulting in 48 reviewers representing 1,087 comments. Comments were reviewed and addressed by the writing committee. A member of the ACCF TF CECD served as lead reviewer to ensure that all comments were addressed adequately. Both the Writing Committee and TF CECD approved the final document to be sent for board review

2012 Society for Cardiovascular Angiography and Interventions

55. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

achieving these targets is limited by signs or symptoms of hypotension. (2D) 3.1.11:We suggest that an ARB or ACE-I be used in children with CKD in whom treatment with BP-lowering drugs is indicated, irrespective of the level of proteinuria. (2D) *Approximate equivalents for albumin excretion rate per 24 hours—expressed as protein excretion rate per 24 hours, albumin-to-creatinine ratio, protein-to- creatinine ratio, and protein reagent strip results— are given in Table 7, Chapter 1. CKD and risk of AKI (...) local practice for people without CKD (and subsequent treatment should be initiated similarly). (1B) 4.2.4: We suggest that clinicians are familiar with the limitations of non-invasive cardiac tests (e.g., exercise electrocardiography [ECG], nuclear imaging, echocardiography, etc.) in adults with CKD and interpret the results accordingly. (2B) 4.3: CKD AND PERIPHERAL ARTERIAL DISEASE 4.3.1: We recommend that adults with CKD be regularly examined for signs of peripheral arterial disease

2012 National Kidney Foundation

57. Linear Immunoglobulin A dermatosis mimicking Toxic Epidermal Necrolysis: a case report of etanercept treatment. (Abstract)

Linear Immunoglobulin A dermatosis mimicking Toxic Epidermal Necrolysis: a case report of etanercept treatment. A 65-year-old pluripathological woman attended our hospital with a cutaneous eruption of sudden appearance after vancomycin treatment. She presented targetoid lesions affecting approximately 25-30% of her body surface, large erosions with mucosal lesions and positive Nikolsky sign. Under the initial clinical suspicion of toxic epidermal necrolysis (TEN), and considering the recent

2017 British Journal of Dermatology

58. Acute Coronary Syndromes (ACS) in patients presenting without persistent ST-segment elevation

), or coronary bypass graft (CABG) surgery], also raises the likelihood of NSTE-ACS. 3.2 Diagnostic tools 3.2.1 Physical examination The physical examination is frequently normal. Signs of heart failure or haemodynamic instability must prompt the physician to expe- dite diagnosis and treatment. An important goal of the physical examination is to exclude non-cardiac causes of chest pain and non-ischaemic cardiac disorders (e.g. pulmonary embolism, aortic dissection, pericarditis, valvular heart disease

2011 European Society of Cardiology

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