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Red Reflex

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61. Major trauma: assessment and initial management

. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 of 23consider using a supraglottic device if the patient's airway reflexes are absent use basic airway manoeuvres and adjuncts if the patient's airway reflexes are present or supraglottic device placement is not possible transport the patient to a major trauma centre for RSI provided the journey time is 60 minutes or less only divert to a trauma unit for RSI before onward transfer if a patent airway (...) ) use a ratio of 1 unit of plasma to 1 unit of red blood cells to replace fluid volume. 1.5.25 For children (under 16s) use a ratio of 1 part plasma to 1 part red blood cells, and base the volume on the child's weight. Haemorrhage protocols in hospital settings Haemorrhage protocols in hospital settings 1.5.26 Hospital trusts should have specific major haemorrhage protocols for adults (16 or over) and children (under 16s). 1.5.27 For patients with active bleeding, start with a fixed-ratio protocol

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

62. CRACKCast E197 – Shock

to the process. [5] What is neurogenic shock, and how does it differ from spinal shock? Neurogenic shock = interrupted sympathetic and parasympathetic input from spinal cord to heart and vasculature. Classically – vasodilation and bradycardia (but can have a wide variation in heart rate depending on other factors). Spinal shock = loss of sensation and motor function following spinal cord injury. reflexes are depressed or absent distal to site of injury. This may last for hours to weeks post-injury. The end (...) of spinal shock is marked by the return of the bulbocavernosus reflex (internal/external anal sphincter contraction in response to squeezing the glans penis or clitoris, or tugging on an indwelling foley). Never checked one of them before. [6] What are the empirical criteria for the diagnosis of circulatory shock? (Box 6.2) Why do we care: ED patients presenting with shock often have no obvious cause. We need to key on key elements of the history/exam to make a diagnosis and start appropriate management

2019 CandiEM

63. New and emerging technologies in neurophysiology and operating theatres

Magnetic resonance imaging MRN Magnetic resonance neurography MS Multiple sclerosis MUNIX Motor Unit Number Index NCS Nerve-conduction studies NHMRC National Health and Medical Research Council NIBS Non-invasive brain stimulation NICE National Institute for Health and Care Excellence (UK) NIRS Near infra-red spectroscopy OSA Obstructive sleep apnoea OSET International) Organisation of Societies for Electrophysiological Technology 6 TECHNOLOGY IN NEUROPHYSIOLOGY AND OPERATING THEATRES | SAX INSTITUTE PA (...) enhanced visual displays of important clinical information — is also likely to become more widespread over the coming years. Non-invasive haemodynamic monitoring technology, to guide fluid management during surgery, appears to be a viable alternative to more invasive techniques. At least one device is commercially available. Based on the results of further trials, such devices may be more widely adopted over the next decade. There is increasing evidence that near infra-red spectroscopy (NIRS

2018 Sax Institute Evidence Check

64. Malignant Spinal Cord Compression

of sphincter control is a late sign with a poor prognosis. Cauda equina syndrome Compression of lumbosacral nerve roots below the level of the cord itself results in a different clinical picture. New, severe root pain affecting low back, buttocks, perineum, thighs, legs. Loss of sensation often with tingling or numbness in the saddle area. Leg weakness, often asymmetrical. Bladder, bowel and sexual dysfunction; occur earlier than in cord compression. Loss of anal reflex. Management Emergency referral (...) are also essential for further information). References Copyright © 2014 NHSScotland Last Updated: 10 Jul 2018 Created: 24 Apr 2014 Indicates this use is off licence Indicates this medication is associated with QT prolongation Colour codes: Red – For medicines normally initiated and used under specialist guidance Amber – For medicines normally initiated by a specialist but may be used by generalists Green – For medicines routinely initiated and used by generalists

2018 Scottish Palliative Care Guidelines

65. Spine imaging

. AIM Specialty Health. All Rights Reserved. 9 General prerequisites for spine imaging: ? Evidence of nerve root or cord compression – objective muscle weakness or sensory abnormality corresponding to a specific dermatome/myotome, reflex changes or spasticity ? Conservative management – a combination of strategies to reduce inflammation, alleviate pain, and improve function, including but not limited to the following: o Prescription strength anti-inflammatory medications and analgesics o Adjunctive (...) imaging is considered medically necessary in ANY of the following scenarios: ? Persistent pain not explained by radiograph and not responsive to a course of conservative therapy of at least 4 weeks duration ? Pain in children younger than age 5 ? Pain accompanied by any red flag features (see Table 1) Table1: Red flag features of low back pain IMAGING STUDY - CT or MRI lumbar spine - CT myelogram Rationale Low back pain (LBP) is currently the second most common cause of disability in the United States

2019 AIM Specialty Health

66. Head and neck imaging

Tumor/Soft Tissue Mass 12 Cholesteatoma 12 Neck mass 12 Parathyroid adenoma 13 Thyroid nodule or thyromegaly (goiter) 13 Tumor – not otherwise specified 14 Nasal Indications 14 Anosmia 14 Cerebrospinal fluid leak 14 Foreign body 14 Mucocele of the paranasal sinus 14 Nasal airway obstruction refractory to medical therapy 14 Nasal or sinus polyposis 14 Recurrent epistaxis 14 Orbital Indications 14 Absence of red reflex (pediatric only) 15 Dysconjugate gaze 15 Exophthalmos or proptosis 15 Extraocular (...) Mucocele of the paranasal sinus Nasal airway obstruction refractory to medical therapy Nasal or sinus polyposis Recurrent epistaxis IMAGING STUDY - CT paranasal sinuses and maxillofacial area Orbital Indications Advanced imaging is considered medically necessary for evaluation of ANY of the following conditions: Head and Neck Imaging Copyright © 2019. AIM Specialty Health. All Rights Reserved. 15 Absence of red reflex (pediatric only) Dysconjugate gaze Exophthalmos or proptosis Extraocular muscle

2019 AIM Specialty Health

67. Appropriate Use Criteria: Imaging of the Brain

for detection of posterior fossa strokes. 119, 121 Headache ADULT Advanced imaging is considered medically necessary in EITHER of the following scenarios: ? New headache o When associated with one or more red flag features (see Table 1) o Headache has not improved or has worsened during a course of physician-directed treatment, and the patient has been reevaluated by a clinician following completion of therapy ? Recurrent headache Imaging of the Brain Copyright © 2019. AIM Specialty Health. All Rights (...) Reserved. 22 o When associated with at least one red flag feature (see Table 1) and advanced imaging (CT or MRI) has not been performed to evaluate the headache o When CT or MRI has been performed to evaluate the headache, and a red flag feature has developed since the prior imaging study o Headaches are increasing in frequency and/or severity despite at least 4 weeks of physician- directed treatment and reevaluation by a clinician following completion of therapy IMAGING STUDY - CT or MRI - CTA or MRA

2019 AIM Specialty Health

68. Diphenhydramine

The purpose of this study is to evaluate the antitussive (cough-suppressing) effects of two liquid medications: a combination of diphenhydramine and phenylephrine in a naturally cocoa flavoring 2014 7. Inhibition of cough reflex sensitivity by diphenhydramine during acute viral respiratory tract infection 25673148 2015 04 27 2016 05 09 2017 02 20 2210-7711 37 3 2015 Jun International journal of clinical pharmacy Int J Clin Pharm Inhibition of cough reflex sensitivity by diphenhydramine during acute viral (...) respiratory tract infection. 471-4 10.1007/s11096-015-0081-8 Currently available over-the-counter cough remedies historically have been criticized for lack of scientific evidence supporting (...) their efficacy. Although the first-generation antihistamine diphenhydramine is classified as an antitussive by the United States Food and Drug Administration, to the authors' knowledge it has never been shown to inhibit cough reflex sensitivity in subjects with pathological cough. To evaluate the effect

2018 Trip Latest and Greatest

70. 34m with fever, headache and myalgias

hospitalized, they diagnosed him with a UTI. This was surprising, because we find out he doesn’t have any dysuria, any flank pain, any overt hematuria. And so I wondered is what the ER physicians actually saw a UA that had white cells and red blood cells on it. So I think thinking broadly about this positive UA and considering well, what reasons could there be for there to be cells in his urine besides a standard UTI was an important clue early on in the case. Sterile pyuria, meaning white cells (...) or lesions. There were no oropharyngeal lesions or cervical LAD. Heart and lung exam were unremarkable. His abdomen was soft and non-tender without any appreciable hepatosplenomegaly. Lower extremity strength, sensation, and reflexes were all within normal limits. CBC was notable for a WBC of 19,200 with 58% neutrophils and 5% bands, a Hgb of 12.4, and a Plt count of 62,000. BMP revealed a K of 3.3 and BUN/Cr of 73/1.6, respectively. LFTs were notable for total bilirubin of 21.2, direct bilirubin of 16.8

2019 Clinical Correlations

71. Paediatric Urology

: 44. 45. Kaefer, M., et al. The incidence of intersexuality in children with cryptorchidism and hypospadias: stratification based on gonadal palpability and meatal position. J Urol, 1999. 162: 1003. 46. Kollin, C., et al. Cryptorchidism: a clinical perspective. Pediatr Endocrinol Rev, 2014. 11 Suppl 2: 240. 47. Caesar, R.E., et al. The incidence of the cremasteric reflex in normal boys. J Urol, 1994. 152: 779. 48. Barthold, J.S., et al. The epidemiology of congenital cryptorchidism, testicular (...) epididymitis in boys: evidence of a post-infectious etiology. J Urol, 2004. 171: 391. 151. Yerkes, E.B., et al. Management of perinatal torsion: today, tomorrow or never? J Urol, 2005. 174: 1579. 152. Boettcher, M., et al. Clinical and sonographic features predict testicular torsion in children: a prospective study. BJU Int, 2013. 112: 1201. 153. Nelson, C.P., et al. The cremasteric reflex: a useful but imperfect sign in testicular torsion. J Pediatr Surg, 2003. 38: 1248. 154. Mushtaq, I., et al

2019 European Association of Urology

74. Global Vascular Guidelines for patients with chronic limb-threatening ischemia

, cardiovascular disease; HDL, high-density lipoprotein. ---- | ---- Fig 2.3 Association of risk factors with the level of atherosclerotic target lesions. The red overlay on the anatomic cartoon illustrates the association of risk factor with patterns of atherosclerotic disease. x 217 Reinecke, H., Unrath, M., Freisinger, E., Bunzemeier, H., Meyborg, M., Lüders, F. et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. Eur Heart J . 2015 ; 36 : 932

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2019 Society for Vascular Surgery

75. Serum Soluble Transferrin receptor

in the concentration of red blood cells or haemoglobin, resulting in lowered ability of the blood to carry oxygen. The two most common forms of anaemia are IDA and ACD (or anaemia of chronic inflammation). The proposed test is an in-vitro diagnostic assay, which quantifies the levels of sTfR in serum and/or plasma samples. sTfR is a marker of iron deficiency when tissue iron stores are depleted in the absence of other causes of abnormal erythropoiesis. sTfR levels are not affected by inflammation, thus sTfR (...) level is 30–100 µg/L, then the full iron study could be done as a reflex test. 12 ESC suggested that MSAC could investigate potential options for the future, such as the use of ferritin tests for specific indications, or the potential to incorporate sTfR into a different pathway, as a bundle with iron studies rather than as an additional test. ESC queried whether there should be different item numbers for different populations, for ease of service provision. 15. Other significant factors Nil 16

2018 Medical Services Advisory Committee

76. CRACKCast E152 – Cardiovascular Drugs

in the myocardium and vascular smooth muscle, leading to coronary and peripheral vasodilation. They also reduce cardiac contractility, depress SA nodal activity, and slow AV conduction. In cases of overdose, verapamil has the deadliest profile , combining severe myocardial depression and peripheral vasodilation. Both verapamil and diltiazem act on the heart and blood vessels, whereas dihydropyridine calcium channel blockers (such as nifedipine) cause primarily vasodilation and subsequent reflex tachycardia (...) in infants up to 4 months old. Methemoglobin is incapable of carrying oxygen, thus it alters the shape of the hemoglobin-dissociation curve shifting it to the left, causing functional anemia via impaired oxygen delivery. 1. What are 2 common clinical presentations of Nitrate/Nitrite toxicity? Hypotension (due to vasodilation) – with reflex tachycardia and headache Low SP02 & cyanosis occurs commonly if the percentage of methemoglobin exceeds 10%. Higher concentrations of methemoglobin may result

2018 CandiEM

77. Voretigene Neparvovec for Biallelic RPE65-Mediated Retinal Disease: Effectiveness and Value

to investigational agent) MLMT Multi-Luminance Mobility Testing OCT Optical Coherence Tomography PDUFA Prescription Drug User Fee Act PLR Pupillary Light Reflex PP Per Protocol RP Retinitis Pigmentosa RPE Retinal Pigment Epithelium SAE Serious Adverse Event SECORD Severe Early Childhood Onset Retinal Dystrophy TEAE Treatment Emergent Adverse Event VA Visual Acuity VF Visual Field VN Voretigene Neparvovec vg Vector Genomes, units in VN product ©Institute for Clinical and Economic Review, 2018 Page ES1 Evidence (...) with intraocular pressure and optic atrophy – 1 pt Myopia requiring correction of >10 diptres and retinal thinning – 1 pt ©Institute for Clinical and Economic Review, 2018 Page 86 Evidence Report – Voretigene Neparvovec Author & Year of Publication (Trial Name) Quality rating Study Design and Duration of Follow-up Interventions (n) & Dosing Schedule Major Inclusion & Exclusion Criteria Patient Characteristics Key Outcomes Harms Pupillary light reflex improvement in all patients Humoral and cell- mediated

2018 California Technology Assessment Forum

78. CRACKCast E147 – General Approach to the Poisoned Patient

collateral information as possible! Aspects of the physical exam not to overlook (clues toward a specific toxin or toxidrome): Airway! Breathing! Circulation… Full vitals, rectal core temperature, glucose LOC, pupillary size, Seizure activity, clonus, reflexes, muscle tone Skin moisture Odour Finally, just because we’re talking Tox, don’t forget about a comprehensive approach to altered mental status! DIMES Lifeinthefastlane has a great mnemonic: R – R – S – I – D – E – A – D – Note: Most tox icologic (...) catecholamines: hypertension, tachycardia, tachypnea, hyperthermia, mydriasis, diaphoresis. Risk for arrhythmias and shock MDMA, Cocaine, amphetamines, cathinones, ephedrine, pseudoephedrine, phenylpropanolamine, theophylline, caffeine Benzo’s Fluids Supportive Anticholinergic “Red as a beet Dry as a bone Blind as a bat Mad as a hatter Hot as hell The bladder keeps its tone and the heart runs alone” Antimuscarinic and antinicotinic properties – leading to a relative sympathomimetic (sympathetic overdrive

2018 CandiEM

79. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

continue to offer ICPi. Should treat skin with topical emollients (if predominately dry skin is observed) and/or mild to moderate potency (hydrocortisone 2.5% or equivalent to triamcinolone 0.1% or equivalent) topical corticosteroids (signs of inflammation/redness with or without itching). Should counsel patients to avoid skin irritants and sun exposure. It is recommended that clinicians manage grade 2 toxicities, including intermittent pruritus, as follows: May hold ICPi and monitor weekly

2018 American Society of Clinical Oncology Guidelines

80. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association

) geometry in health and disease. Three-dimensional reconstructions of the RV illustrating its complex shape in a normal subject ( A ). RV remodeling in diseased hearts can result in profound shape change with RV dilation caused by chronic volume or pressure overload ( B ). The red mesh surface is the left ventricle (LV), and the solid blue surface is the RV. P indicates pulmonary valve; and T, tricuspid valve. Reprinted from Sheehan and Redington with permission from BMJ Publishing Group, Ltd. Copyright

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2018 American Heart Association

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