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Occlusive Dressing

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161. Evaluation and Management of Right-Sided Heart Failure (Full text)

is prevalent in ≈50% of patients with an acute inferior MI. A functionally-relevant acute RVMI generally requires disruption of blood flow to both the RV free wall and a portion of the interventricular septum. It typically occurs when a dominant right coronary artery is occluded proximally to the major RV branch(es), leading to reduced RV systolic function and acute RV dilation. A smaller proportion of patients have RVMI resulting from circumflex coronary artery occlusion in a left-dominant coronary system (...) and rarely in association with left anterior descending coronary artery occlusion, in which this artery supplies collaterals to an otherwise underperfused anterior portion of the RV free wall. RVMI is associated with hemodynamic compromise in 25% to 50% of patients presenting with this infarct pattern. Early mortality is highest among patients with evidence of hemodynamic compromise. , Patients with RVMI have a greater burden of arrhythmias, contributing to mortality. Most patients recover RV function

2018 International Society for Heart and Lung Transplantation PubMed

162. An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome (Full text)

radial artery (RA) occlusion (RAO) as a vascular complication, likely because the clinical significance of RAO remains controversial. In the RIVAL trial, the incidence of major vascular access site complications was significantly lower in the TRA group (1.4% versus 3.7%; HR, 0.37; 95% CI, 0.27–0.52), and the incidence of symptomatic RAO was extremely low (0.2%). In patients with STEMI, the incidence of major vascular access complications was 1.2% with TRA and 3.4% with TFA ( P =0.002). Although (...) transfusion. , TRA is also preferable in patients who have difficulty lying flat (eg, those with congestive heart failure, low back pain, cognitive impairment). Relative contraindications to the radial approach are limited but include severe vaso-occlusive disease (eg, Raynaud disease, Takayasu arteritis, thromboangiitis obliterans), documented small RA size, or known complex radial or brachiocephalic anatomy. The impact of TRA on subsequent utility of the RA as a bypass conduit or in patients who may

2018 American Heart Association PubMed

163. Guidelines for the use of hydroxycarbamide in children and adults with sickle cell disease (Full text)

anaemia (SS), sickle cell/haemoglobin C (SC) sickle cell/βthalassemia (S/β thal) and other compound heterozygous conditions. SCD is characterised by the presence of the mutated β‐globin gene, HBB s (also termed β s ‐globin). On de‐oxygenation, this forms a polymeric structure resulting in deformed, rigid red blood cells, and is associated with a chronic haemolytic anaemia due to shortened red cell life span and vaso‐occlusion causing frequent episodes of severe bony pain (vaso‐occlusive crises (...) of HbF and acts via multiple mechanisms to improve blood flow and reduce vaso‐occlusion (Green & Barral, ). In part, this is due to decreased expression of integrins and other adhesion molecules on red cells, white blood cells (WBCs) and vascular endothelium. The interactions between these cells are involved in neutrophil migration and red blood cell flow and reduction of adhesion leads to decreased vaso‐occlusion. Nitric oxide (NO) levels are decreased in patients with SCD and stimulation

2018 British Committee for Standards in Haematology PubMed

164. Respiratory distress including CPAP - neonatal

the catheter anterior to the lung is critically important, and this may be facilitated by having an assistant roll the baby away from you after you have the catheter in the pleural space Notes · If drainage is ineffective contact higher level neonatal service · If choosing to suture the ICC, do not use a purse string suture as this will produce a puckered scar · Tape with transparent, bio-occlusive dressing by sandwiching the catheter between the two pieces [refer to Figure 6], or use two wide steristrips (...) gauge butterfly needle or 24 gauge intravenous cannula · 3-way stopcock · 10 or 20 mL syringe · Alcohol wipe for skin preparation - · Sterile dressing pack Site · Avoid the heart, internal mammary artery and the intercostal arteries · Use either: o 2nd intercostal space, mid-clavicular line OR o 4th intercostal space, anterior axillary line · Insert the needle as near as possible to the upper edge of the lower rib · Refer to Figure 1. Needle aspiration Procedure · Attach a 23 gauge butterfly needle

2018 Queensland Health

165. Neonatal stabilisation for retrieval

tidal CO2 detector o Improved oxygenation · Tape securely o Apply hydrocolloid dressing to cheeks and use adhesive tape to secure ETT o Secure to middle of upper lip · Check ETT position on X-ray: o Correct position of ETT tip § Visible just below the medial ends of the clavicles 36,37 § Approximately at the level of the first to second thoracic vertebrae 38 § Mid trachea above the carina (1–2 cm) Ventilator settings · Peak inspiratory pressure (PIP)18–20 cm H2O o May need adjustment § To achieve (...) information Assistance · Procedures (e.g. use of dressing trolley) · Organisation of external services such as imaging, security Expressed breast milk (EBM) · Labelled and packaged in a container with ice to keep cold o Refer to Queensland Clinical guideline Establishing breastfeeding 73 11 Parents If retrieval or transfer is required, it is desirable but not always possible for one parent to travel with the baby. This will depend on: · Type of transport · Maternal medical condition (the women may

2018 Clinical Practice Guidelines Portal

166. 2018 IDSA Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy

infusion without home nursing offers another model of self-administered OPAT (S-OPAT). Here, a physician’s office provides training and supervision, either in private practice or in a clinic setting. Typically, patients make weekly visits to the office to collect supplies and undergo assessment and catheter dressing changes. Critical to the success of home-based OPAT is the presence of a competent and adherent patient and/or caregiver. Minimal features required for safe home infusion include adequate (...) antimicrobials at home. In the United States, once the patient has established infusion competency, the home care model generally includes a once-weekly visit by a nurse who performs clinical assessment, changes the VAD dressings, and draws blood for monitoring tests, with the option to visit patients’ homes more frequently if needed. In time, other models of care have evolved, including the use of various office or infusion center settings. However, the majority of OPAT in the United States continues

2018 Infectious Diseases Society of America

168. 2018 guidelines for the early management of patients with acute ischemic stroke

of clinical questions identified in conjunction with the writing group, the results of which were considered by the writing group for incorporation into this guideline. The systematic reviews “Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke” and “Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic (...) imaging ED Emergency department EMS Emergency medical services EVT Endovascular therapy GA General anesthesia GWTG Get With The Guidelines HBO Hyperbaric oxygen HR Hazard ratio ICH Intracerebral hemorrhage IPC Intermittent pneumatic compression IV Intravenous LDL-C Low-density lipoprotein cholesterol LMWH Low-molecular-weight heparin LOE Level of evidence LVO Large vessel occlusion M1 Middle cerebral artery segment 1 M2 Middle cerebral artery segment 2 M3 Middle cerebral artery segment 3 MCA Middle

2018 American Academy of Neurology

169. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

. An independent evidence review committee was commissioned to perform a systematic review of a limited number of clinical questions identified in conjunction with the writing group, the results of which were considered by the writing group for incorporation into this guideline. The systematic reviews “Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic (...) Door-to-needle DVT Deep vein thrombosis DW-MRI Diffusion-weighted magnetic resonance imaging ED Emergency department EMS Emergency medical services EVT Endovascular therapy GA General anesthesia GWTG Get With The Guidelines HBO Hyperbaric oxygen HR Hazard ratio ICH Intracerebral hemorrhage IPC Intermittent pneumatic compression IV Intravenous LDL-C Low-density lipoprotein cholesterol LMWH Low-molecular-weight heparin LOE Level of evidence LVO Large vessel occlusion M1 Middle cerebral artery segment

2018 American Heart Association

170. Management of Diabetic Foot

of Treatment Appendix 10. Types of Wound Dressings 55 in Diabetic Foot List of Abbreviations 57 Acknowledgement 58 Disclosure Statement 58 Source of Funding 59Management of Diabetic Foot (Second Edition) i LEVELS OF EVIDENCE SOURCE: US / CANADIAN PREVENTIVE SERVICES TASK FORCE 2001 FORMULATION OF RECOMMENDATION In line with new development in CPG methodology, the CPG Unit of MaHTAS is adapting Grading Recommendations, Assessment, Development and Evaluation (GRADE) in its work process. The quality of each (...) of Diabetic Foot (Second Edition) d. Treatment • Appropriate analgesia should be considered in painful diabetic foot. • Antibiotics should be used as an adjunct to surgical debridement in infected diabetic foot. • Advanced wound dressings may be offered in diabetic foot ulcer. • Adjuvant therapy may be offered in delayed wound healing in diabetic foot with good vascularity. • Revascularisation should be offered in diabetic patients with peripheral arterial disease. • Surgical debridement by trained

2018 Ministry of Health, Malaysia

171. Paediatric Urology

during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents. J Pediatr Urol, 2014. 10: 435. 310. Fayad, F., et al. Percutaneous retrograde endovascular occlusion for pediatric varicocele. J Pediatr Surg, 2011. 46: 525. 311. Thon, W.F., et al. Percutaneous sclerotherapy of idiopathic varicocele in childhood: a preliminary report. J Urol, 1989. 141: 913. 312. Locke, J.A., et al. Treatment of varicocele in children and adolescents: A systematic review and meta-analysis

2018 European Association of Urology

172. Urological Trauma

. Hammer, C.C., et al. Effect of an institutional policy of nonoperative treatment of grades I to IV renal injuries. J Urol, 2003. 169: 1751. 74. Jawas, A., et al. Management algorithm for complete blunt renal artery occlusion in multiple trauma patients: case series. Int J Surg, 2008. 6: 317. 75. Armenakas, N.A., et al. Indications for nonoperative management of renal stab wounds. J Urol, 1999. 161: 768. 76. Jansen, J.O., et al. Selective non-operative management of abdominal gunshot wounds: survey

2018 European Association of Urology

173. Urological Infections

. Contemporary diagnosis and management of Fournier’s gangrene. Ther Adv Urol, 2015. 7: 203. 277. Eke, N. Fournier’s gangrene: a review of 1726 cases. Br J Surg, 2000. 87: 718. 278. Subrahmanyam, U., et al. Honey dressing beneficial in treatment of fournier’s gangrene. Indian J Surg, 2004. 66: 75. 279. Jallali, N., et al. Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg, 2005. 189: 462. 280. Karian, L.S., et al. Reconstruction of Defects After Fournier Gangrene

2018 European Association of Urology

174. Use of Vital Pulp Therapies in Primary Teeth with Deep Caries Lesions

to maintain the highest standard of care and to ensure patient safety. 41 It is also important that clinicians select the best post- operative restoration using their clinical expertise and individual patient preferences. Either intra-coronal restoration or a stainless steel crown (SSC) may be adequate to achieve a good marginal seal for single surface (occlusal) restorations on a primary tooth with a life span of two years of less; whereas for multi-surface restorations, stainless steel crowns

2017 American Academy of Pediatric Dentistry

175. CrackCAST E136 – Bone and Joint Infections

dressings. Really depends on the population and risk factors. If concerned about pseudomonas (puncture wounds to the feet) – add fluoroquinolone or ceftazidime / cefepime g. if a diabetic with osteomyelitis consider adding clindamycin or metronidazole on to the regimen (Clavulin + Septra) An easy regimen for most: 3rd Gen cephalosporin Vancomycin If not concerned RE: MRSA Amoxicillin-clavulanate is a good PO choice. Diabetic foot infections : According to ASPIRES guidelines PO options Amox-Clav (...) arthritis Joint Complications Destruction of articular cartilage Destruction of joint Ankylosis Growth plate disruption or destruction AVN, especially from vascular occlusion in neonatal femoral heads Surrounding structure infection Bursae Tendons Ligaments Muscles Skin Systemic Complications Sepsis Endocarditis Pneumonia Abscesses [11] What is the triad of disseminated Gonococcal disease? Gonococcal disease can present as either: Mono-oligoarticular arthritis True disseminated gonococcal infection

2017 CandiEM

177. CRACKCast E063 – Thermal Burns

’ manner Topical antimicrobials (e.g. neomycin, mupirocin, silver sulfadiazine) Nonadherent dressing Daily dressing exchange and gentle cleansing with water and soap The second method for burn management is with occlusive dressings Support a moist wound-healing environment Less pain as dressings are not exchanged daily Most appropriate for superficial partial-thickness burns with no signs of infection Dressing such as Mepilex or a nano-crystaline silver-containing occlusive dressing should be applied (...) sensitive areas (e.g. face, ears, joints, perineum, hands, feet) Escharotomy required [8] Describe basic burn dressing management ABC’s Analgesia, analgesia, analgesia Prevent hypothermia! Assume burns are contaminated: clean and debride gently Tetanus toxoid booster if eligible (>5 years since last) If the patient did not complete primary series, TIG Leave blisters intact, debride ruptured blisters Dressings for partial-thickness burns Clearly infected, purulent wounds should be managed in an ‘open

2017 CandiEM

178. Radiologic Management of Central Venous Access

or chest veins, catheter placement in the inferior vena cava via infra-umbilical, trans-lumbar or trans-hepatic approaches, and right atrial catheter placement via trans-hepatic venous approach. Collateral neck or chest wall veins develop in response to chronic CV narrowing and occlusion. In patients with a well-established collateral network via mediastinal, intercostal, paraspinal, or azygos veins, access via these vessels is unlikely to result in symptomatic CV obstruction. Procedure-related (...) complication rates are comparable to those via conventional venous access sites [54]. When all options for permanent catheter placement in the chest have been exhausted, femoral venous access or trans-lumbar inferior vena cava access may be considered. Femoral vein access should not be used without first considering lower extremity fistula formation. Permanent femoral catheters are associated with a higher rate of infection and occlusion, resulting in more frequent interventions for catheter maintenance

2017 American College of Radiology

179. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

to cause progressive arterial stenosis in KD patients with coronary artery abnormalities. Figure 1. Epicardial coronary artery (right) and epicardial vein (left) from a 19-month-old child who died 10 months after Kawasaki disease onset. The epicardial vein contains blood and shows mild thickening of the wall, while the coronary artery shows almost complete occlusion by luminal myofibroblastic proliferation with a fine slit-like lumen. Pathological outcomes of coronary artery damage depend (...) in diameter or with a Z score ≥10 do not “resolve,” “regress,” or “remodel.” They rarely rupture and virtually always contain thrombi (the oldest of which may calcify) that can become occlusive. Aneurysms with markedly damaged but partially preserved media may develop decreases in lumen diameter over time as the result of LMP or thrombi and can become progressively stenotic. Atherosclerotic features are not characteristic of KD vasculopathy even in late deaths or transplants. Pericarditis and myocarditis

2017 American Heart Association

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