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221. Geriatric Trauma Management

- Generation Antipsychotics on page 15 for full list) Increased risk of cerebrovascular accident (stroke) and mortality in persons with dementia Avoid use for behavioral problems of dementia unless nonpharmacologic options have failed and patient is threat to self or others Moderate Strong Thioridazine Mesoridazine Highly anticholinergic and greater risk of QT- interval prolongation Avoid Moderate Strong Barbiturates z Amobarbital* z Butabarbital* z Butalbital z Mephobarbital* z Pentobarbital* z (...) emphasize the following: z Determine medications that affect initial evaluation and care.  Coumadin  Clopidogrel  Other anticoagulants  ASA  Beta blockers  ACE inhibitors z Consider common, acute, nontraumatic events that could complicate the patient’s presentation, including:  Acute coronary syndrome (EKG)  Hypovolemia/dehydration  Urinary tract infection  Pneumonia  Acute renal failure  Cerebrovascular event  Syncope z Lab assessment: Hypoperfusion is often underappreciated in the elderly

2013 American College of Surgeons

222. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

) was a CV and renal outcomes trial in which the direct renin inhibitor aliskiren or placebo was added to RAS-blocking therapy in patients with type 2 diabetes, CKD, and high CV risk. This double- blind placebo-controlled study of 8,561 participants had a primary end point of time to ?rst occurrence of CV death, resuscitated cardiac arrest, nonfatal myocar- dial infarction, nonfatal stroke, unplanned hospitaliza- tion for heart failure, onset of end-stage renal disease, or doubling of serum creatinine (...) Hg. An updated stan- dards of care document released by the American Diabetes Association in January 2013 recommended treating all patients with diabetes and hypertension to a goal of140/80 mm Hg regardless of the presence of CKD, with the caveat that a lower systolic target, such as130 mm Hg, may be appropriate for those with longer life expectancy or at higher risk for stroke. 18 Both guidelines recommend a goal for sys- tolic blood pressure that is concordant with KDIGO. Given that systolic

2012 National Kidney Foundation

223. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

) 4.1.2: We recommend that the level of care for ischemic heart disease offered to people with CKD should not be prejudiced by their CKD. (1A) 4.1.3: We suggest that adults with CKD at risk for atherosclerotic events be offered treatment with antiplatelet agents unlessthereisanincreasedbleedingriskthatneedstobebalancedagainstthepossiblecardiovascularbene?ts.(2B) 4.1.4: WesuggestthatthelevelofcareforheartfailureofferedtopeoplewithCKDshouldbethesameasisofferedto those without CKD. (2A) 4.1.5: In people (...) . (2B) 5.2.2: The multidisciplinary team should include or have access to dietary counseling, education and counseling about different RRT modalities, transplant options, vascular access surgery, and ethical, psychological, and social care. (Not Graded) 5.3: TIMING THE INITIATION OF RRT 5.3.1: We suggest that dialysis be initiated when one or more of the following are present: symptoms or signs attributable to kidney failure (serositis, acid-base or electrolyte abnormalities, pruritus); inability

2012 National Kidney Foundation

224. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease (SIHD)

to: accuracy, angina, asymptomatic patients, cardiac magnetic resonance (CMR), cardiac rehabilitation, chest pain, chronic angina, chronic coronary occlusions, chronic ischemic heart disease (IHD), chronic total occlusion, connective tissue disease, coronary artery bypass graft (CABG) versus medical therapy, coronary artery disease (CAD) and exercise, coro- nary calcium scanning, cardiac/coronary computed tomogra- phy angiography (CCTA), CMR angiography, CMR imag- ing, coronary stenosis, death, depression (...) myocardial infarction, history of heart failure, and prior aspirin use. †For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B only), studies that support the use of comparator verbs should involve direct comparisons of the treatments or strategies being evaluated. 2567 JACC Vol. 60, No. 24, 2012 Fihn et al. December 18, 2012:2564–603 Stable Ischemic Heart Disease: Executive Summary Downloaded From: http://content.onlinejacc.org/ on 09/09/2014quality and availability

2012 Society for Cardiovascular Angiography and Interventions

225. AAN Guideline on Intravenous Immunoglobulin in the Treatment of Neuromuscular Disorders

in the treatment of LEMS (Level C). Adverse effects of IVIg. Eighteen of the 22 prospective studies reviewed recorded the number of serious and minor AEs from 632 patients receiving IVIg (total dose 2.0–2.5 g/kg). There were no IVIg-related deaths in these studies. Most studies concluded that IVIg was well-tolerated and AEs were either transient or manageable. Serious AEs related to IVIg were rare and included aseptic meningitis (n = 3), urticaria (n = 2), heart failure (n = 1), myocardial infarction (n = 1 (...) ), and renal failure (n = 1). These findings do not exclude the possibility of rare AEs such as stroke and thrombotic events, which have been previously reported with IVIg. It is important to screen for vascular risk factors before infusion and to monitor carefully during and after infusion. , , The most common IVIg-related AEs included headache (16.1%), fever (6.6%), mild hypertension (4.6%), chills (3.3%), nausea (3.2%), asthenia (1.4%), arthralgia (1.3%), anorexia (1.1%), dizziness (1.1%), malaise (1.1

2012 American Association of Neuromuscular & Electrodiagnostic Medicine

226. A Call to Action: Women and Peripheral Artery Disease Full Text available with Trip Pro

Lower extremity atherosclerotic peripheral artery disease (PAD) has a very high prevalence in most nations and in the United States. Lower extremity PAD is now known to be associated with equal morbidity and mortality and comparable (or higher) health economic costs as coronary heart disease (CHD) and ischemic stroke. , Yet where surveyed, the public and clinicians (as well as health payers and government agencies) do not yet fully recognize the risks associated with PAD. For decades, clinicians did (...) A. Nussmeier , and Diane Treat-Jacobson and on behalf of the American Heart Association Council on Peripheral Vascular Disease and Council on Cardiovascular Nursing and Council on Cardiovascular Radiology and Intervention and Council on Cardiovascular Surgery and Anesthesia and Council on Clinical Cardiology and Council on Epidemiology and Prevention Originally published 15 Feb 2012 Circulation. 2012;125:1449–1472 You are viewing the most recent version of this article. Previous versions: Introduction

2012 American Heart Association

227. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

mortality. [Quality of evidence: very low] Numerous reports have associated hyperglycemia with a poor patient outcome (1–3, 8–11). Retrospective analysis of 259,040 admissions demonstrated a significant association between hyperglycemia and higher adjusted mortality in unstable angina, acute myocardial infarction, congestive heart failure, arrhythmia, ischemic and hemorrhagic stroke, gastrointestinal bleeding, acute renal failure, pneumonia, pulmonary embolism, and sepsis ( ). The mortality risk (...) , insulin infusion, insulin protocols, insulin resistance, insulin therapy, intensive care, intensive insulin therapy, mortality, myocardial infarction, neurocognitive function, neuroprotection, outcomes, pediatric, pediatric intensive care, point-of-care, point-of-care testing, sepsis, sternal wound infection, stress hyperglycemia , stress, stress hormones, stroke, subarachnoid hemorrhage, surgery, tight glycemic control protocols, and traumatic brain injury (TBI). Published clinical trials were used

2012 Society of Critical Care Medicine

228. ACCF/AHA/AMA-PCPI 2011 Performance Measures for Adults With Heart Failure Full Text available with Trip Pro

disease receive optimal care ( ). Table 1. ACCF/AHA Performance Measure Sets Topic Original Publication Date Partnering Organizations Status Heart failure 2005 ACC/AHA—inpatient measures Updated 2011 ACC/AHA/AMA-PCPI—outpatient measures Chronic stable coronary artery disease 2005 ACC/AHA/AMA-PCPI Updated 2011 Hypertension 2005 ACC/AHA/AMA-PCPI Updated 2011 ST-elevation and non–ST-elevation myocardial infarction 2006 ACC/AHA Updated 2008 Cardiac rehabilitation 2007 AACVPR/ACC/AHA Updated 2010 (referral (...) measures only) Atrial fibrillation 2008 ACC/AHA/AMA-PCPI Primary prevention of cardiovascular disease 2009 AHA/ACCF Peripheral artery disease 2010 ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS Percutaneous coronary intervention 2012 ACCF/AHA/SCAI/AMA-PCPI/NCQA Cardiac imaging 2012 ACCF/AHA/ACR/AMA-PCPI/NCQA AACVPR indicates American Association of Cardiovascular and Pulmonary Rehabilitation; ACC, American College of Cardiology; ACCF, American College of Cardiology Foundation; ACR, American College of Radiology

2012 American Heart Association

229. Clinical Recommendations for Cardiopulmonary Exercise Testing Data Assessment in Specific Patient Populations Full Text available with Trip Pro

exertional dyspnea is related to a pulmonary mechanism, particularly exercise-induced bronchospasm When relevant, should be assessed prior to and following CPX for comparative purposes <15% reduction from pre to post CPX for both variables O 2 pulse trajectory (mL O 2 · beat −1 ) O 2 pulse defined as the ratio between V o 2 (mL O 2 · min −1 ) and HR (bpm) Non-invasively reflects stroke volume response to exercise Has diagnostic utility in patients with suspected myocardial ischemia (ie, exercise-induced (...) Leipzig, Leipzig, Germany3Department of Cardiology, Antwerp University Hospital, Edegem, Belgium4Department of Prevention and Sports Medicine, Technische Universität München, Munich, Germany; Munich Heart Association, Munich, Germany5Exercise Pathophysiology Laboratory, Cardiac Rehabilitation Division, S. Maugeri Foundation IRCCS, Scientific Institute of Veruno, Veruno (NO), Italy6Research Centre for Cardiovascular and Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven

2012 American Heart Association

230. 2013 ISHLT Guidelines for Mechanical Circulatory Support

examination as a screen for occult vascular disease. Level of evidence: C. 3. CT scan or magnetic resonance imaging is warranted in patients with previous stroke to establish a pre-operative baseline study. Level of evidence: C. Class III: 1. MCS is not recommended in patients with neuromuscular disease that severely compromises their ability to use and care for external system components or to ambulate and exercise. Level of evidence: C. Recommendations for coagulation and hematologic disorders: 40–44 (...) Obstruction (rare) Outflow Obstruction (very rare) Hypovolemia or Obstruction Figure 1 Treatment algorithm for low pump output. AV, arteriovenous; CI, cardiac index; CVP, central venous pressure; Hgb, hemoglobin; LA, left atrium; LV, left ventricle; MAP, mean arterial pressure; PAOP, pulmonary artery occlusion pressure; PAP, pulmonary artery pressure; PRBC, packed red blood cells; PVR, peripheral vascular resistance; RA, right atrium; RV, right ventricular; RVAD, right ventricular assist device. Feldman

2013 International Society for Heart and Lung Transplantation

231. Dysphagia

to evaluate a patient’s oropharyngeal swallow and to examine the effectiveness of rehabilitation strategies [9,10]. The modified barium swallow focuses on the oral cavity, pharynx, and cervical esophagus to assess abnormalities of both the oral phase of swallowing (ie, difficulty propelling the bolus) and the pharyngeal phase (ie, laryngeal penetration, tracheal aspiration, cricopharyngeal dysfunction). Dynamic evaluation of swallowing function can assess bolus manipulation, tongue motion, hyoid (...) the patient. Typical functional and neurologic causes of oropharyngeal dysphagia include recent stroke, worsening dementia, myasthenia gravis, or amyotrophic lateral sclerosis. Many patients with oropharyngeal dysphagia can subjectively localize a sensation of blockage or discomfort in the throat. Patients with oropharyngeal dysphagia typically complain of food sticking in the throat or of a globus sensation with a lump in the throat. Other symptoms of oropharyngeal dysfunction include coughing or choking

2013 American College of Radiology

232. Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain

of morphine equivalent dosage by 35%, compared prior to 2007. Further, there was also a 50% decrease from 2009 to 2010 in the number of deaths. Opioid prescribing may be different for different specialities and settings based on the speciality and training. Consequently, additional modalities may be utilized instead of high dose opioid therapy, leading to low or moderate dose opioid therapy and avoid- ing multiple complications (182). These include various techniques of rehabilitation with therapeutic

2012 American Society of Interventional Pain Physicians

233. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular DiseaseA Report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Full Text available with Trip Pro

stenosis or occlusion of the cervical portion of the carotid arteries ( ). Other causes of carotid artery disease include fibromuscular dysplasia, arteritis, radiation-induced arteriopathy, dissection, and restenosis following carotid artery revascularization procedures. Extracranial vertebral and intracranial cerebral artery diseases are outside the scope of this document. The data elements defined in include symptoms and clinical findings related to ischemic strokes and transient ischemic attacks (...) . ( 2011 ) Executive summary: standards of medical care in diabetes—2011 . National Heart, Lung and Blood Institute–National Cholesterol Education Program . . Accessed August 11, 2011 . Centers for Medicare & Medicaid Services ( 2010 ) Health Information Technology for Economic and Clinical Health Act–Electronic Health Record Incentive Program; Final Rule . Accessed August 11, 2011 , . Easton J.D. , Saver J.L. , Albers G.W. , et al. ( 2009 ) Definition and evaluation of transient ischemic attack

2012 Society of Interventional Radiology

234. Statement Regarding the Pre and Post Market Assessment of Durable, Implantable Ventricular Assist Devices in the United States Full Text available with Trip Pro

, Massachusetts (LS); Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan (KDA); Department of Cardiovascular Sciences, University of South Florida, Tampa, Florida (LM); Department of Cardiothoracic Surgery, University of Alabama, Birmingham, Birmingham, Alabama (DN); Division of Cardiology, Northwestern University, Chicago, Illinois (CY); Division of Cardiology, Duke University, Durham, North Carolina (JR); Heart and Vascular Institute, University of Pittsburgh Medical Center (...) of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan (KDA); Department of Cardiovascular Sciences, University of South Florida, Tampa, Florida (LM); Department of Cardiothoracic Surgery, University of Alabama, Birmingham, Birmingham, Alabama (DN); Division of Cardiology, Northwestern University, Chicago, Illinois (CY); Division of Cardiology, Duke University, Durham, North Carolina (JR); Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (JT

2012 American Heart Association

235. Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline from the ACP, ACCP, ATS, and the ERS

nonanticholinergic respiratory medications com- pared with placebo plus any other nonanticholinergic re- spiratory medications) found a reduced risk for myocardial infarction with long-acting inhaler tiotropium compared with placebo (RR, 0.73 [CI, 0.53 to 1.00]) and no differ- ence in risk for stroke (23). Evidence to Use Combination Therapy in Patients With FEV 1 Between 50% and 80% Predicted One study of patients with FEV 1 between 50% and 80% predicted who were treated with the combination of a long-acting (...) of various inhaled therapies (an- ticholinergics, long-acting -agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy. Methods: This guideline is based on a targeted literature update from March 2007 to December 2009 to evaluate the evidence and update the 2007 ACP clinical practice guideline on diagnosis and management of stable COPD. Recommendation 1: ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in pa

2011 American Thoracic Society

236. Complex Regional Pain Syndrome (CRPS-2011)

Complex Regional Pain Syndrome (CRPS-2011) Effective October 1, 2011 Hyperlink and Formatting update September 2016 Work-Related Complex Regional Pain Syndrome (CRPS): Diagnosis and Treatment 2011 TABLE OF CONTENTS I. Introduction II. Establishing Work-Relatedness III. Prevention A. Know the Risk Factors B. Identify Cases Early and Take Action C. Encourage Active Participation in Rehabilitation IV. Making the Diagnosis A. Symptoms and Signs B. Three-Phase Bone Scintigraphy C. Diagnostic (...) October 1, 2011 Hyperlink and Formatting update September 2016 Page 2 Work-Related Complex Regional Pain Syndrome (CRPS): Diagnosis and Treatment I. INTRODUCTION This guideline is to be used by physicians, claim managers, occupational nurses, all other providers and utilization review staff. The emphasis is on accurate diagnosis and treatment that is curative or rehabilitative (see WAC 296-20-01002 for definitions). This guideline was developed in 2010 – 2011 by the Industrial Insurance Medical

2011 Washington State Department of Labor and Industries

237. Cardiovascular Disease Prevention in Women: Evidence-Based Guidelines For

counterparts (286.1/100,000 ver- sus 205.7/100,000). This disparity parallels the substantially lower rate of awareness of heart disease and stroke that has been documented among black versus white women (2,6–8). Of concern is that in a recent AHA national survey, only 53% of women said the ?rst thing they would do if they thought they were having a heart attack was to call 9-1-1. This distressing lack of appreciation by many women for the need for emergency care for acute cardiovascular events (...) associated with a 4- to 5-fold increased risk of ischemic stroke and is responsible for 15% to 20% of all ischemic strokes. It has been shown that undertreatment with anticoagulants doubles the risk of recurrent stroke; therefore, the expert panel voted to include recommendations for the prevention of stroke among women with atrial ?brillation (6,9,10). Adverse trends in CVD risk factors among women are an ongoing concern. After 65 years of age, a higher percentage of women than men have hypertension

2011 American College of Cardiology

238. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease Full Text available with Trip Pro

, asymptomatic patients, cardiac magnetic resonance (CMR), cardiac rehabilitation, chest pain, chronic angina, chronic coronary occlusions, chronic ischemic heart disease (IHD), chronic total occlusion, connective tissue disease, coronary artery bypass graft (CABG) versus medical therapy, coronary artery disease (CAD) and exercise, coronary calcium scanning, cardiac/coronary computed tomography angiography (CCTA), CMR angiography, CMR imaging, coronary stenosis, death, depression, detection of CAD (...) , myocardial infarction (MI), noninvasive testing and mortality, nuclear myocardial perfusion, nutrition, obesity, outcomes, patient follow-up, patient education, prognosis, proximal left anterior descending (LAD) disease, physical activity, reoperation, risk stratification, smoking, stable ischemic heart disease (SIHD), stable angina and reoperation, stable angina and revascularization, stress echocardiography, radionuclide stress testing, stenting versus CABG, unprotected left main, weight reduction

2011 American Heart Association

239. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary Full Text available with Trip Pro

Occlusions 2589 4.7.2. Saphenous Vein Grafts 2589 4.7.3. Bifurcation Lesions 2589 4.7.4. Aorto-Ostial Stenoses 2589 4.7.5. Calcified Lesions 2591 4.8. PCI in Specific Patient Populations 2591 4.8.1. Chronic Kidney Disease 2591 4.9. Periprocedural Myocardial Infarction Assessment 2591 4.10. Vascular Closure Devices 2591 5. Postprocedural Considerations: Recommendations 2591 5.1. Postprocedural Antiplatelet Therapy 2591 5.1.1. Proton Pump Inhibitors and Antiplatelet Therapy 2591 5.1.2. Clopidogrel Genetic (...) . PCI in Hospitals Without On-Site Surgical Backup 2583 4. Procedural Considerations: Recommendations 2583 4.1. Vascular Access 2583 4.2. PCI in Specific Clinical Situations 2583 4.2.1. Unstable Angina/Non–ST-Elevation Myocardial Infarction 2583 4.2.2. ST-Elevation Myocardial Infarction 2584 4.2.3. Cardiogenic Shock 2585 4.2.4. Revascularization Before Noncardiac Surgery 2585 4.3. Coronary Stents 2586 4.4. Adjunctive Diagnostic Devices 2586 4.4.1. Fractional Flow Reserve 2586 4.4.2. Intravascular

2011 American Heart Association

240. 2011 ACCF/AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy Full Text available with Trip Pro

during atrial systole is associated with these alterations. With exercise or any other type of catecholamine stimulation, the decrease in diastolic filling period as well as myocardial ischemia will further lead to severe abnormalities of diastolic filling of the heart, with chest pain and/or an increase in pulmonary venous pressure causing dyspnea. 4.3. Myocardial Ischemia Severe myocardial ischemia and even infarction may occur in HCM. , The myocardial ischemia is frequently unrelated (...) . . . . . . . . . . . . . . . . . .e789 2.2.4. Hypertrophic Cardiomyopathy Centers . .e789 Clinical Course and Natural History, Including Absence of Complications . . . . . . . . . . . . . . . . . . . . .e790 Pathophysiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . .e790 4.1. LVOT Obstruction. . . . . . . . . . . . . . . . . . . . . . . .e790 4.2. Diastolic Dysfunction . . . . . . . . . . . . . . . . . . . . .e791 4.3. Myocardial Ischemia . . . . . . . . . . . . . . . . . . . . . .e791 4.4. Autonomic Dysfunction

2011 American Heart Association

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