Critical Care
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Hospital Medicine Alert - Full January 2015 Issue in PDF
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Thienopyridine Pretreatment in Patients with Non-ST Elevation Acute Coronary Syndromes: Where’s the Evidence?
Each year when I lecture the incoming cardiology fellows on the management of non-ST elevation acute coronary syndromes (NSTE-ACS), we embark on a discussion of optimal guideline-driven treatment vs. real-world practicalities. -
If Less is More, How Can We Get There?
This study, done at a tertiary care university hospital here in the U.S., was initiated in an attempt to improve patient safety, conserve a vital resource, and reduce costs a laudable tripartite goal. -
Side Effects of Opioids
More than 40% of ED visits are related to pain.1 The Joint Commission has made the assessment and treatment of pain in the ED one of its standards.2 The use of opioid medications has been increasing in both adults and children.3-5 In 2009 there were more than 200 million prescriptions for opioid medications, with enough medication dispensed to supply every adult in the United States with the equivalent of 5 mg of hydrocodone every four hours for one month.
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Ebola Virus Disease and the ICU Clinician
As hospitals in the United States and other resource-intensive countries prepare for the care of patients with possible Ebola virus disease, the greatest impact on its clinical outcome and further spread will most likely come from the application of existing basic critical-care and infection-control principles. -
After-Hours ICU Discharge: A Potentially Modifiable Cause of Increased Hospital Mortality
Examination of outcomes in 710,535 patients in relation to the timing of ICU discharge showed that being moved out to the ward between 1800 and 0600 hours was associated with increased risks of both in-hospital death and unplanned ICU readmission. -
Unplanned Extubations as a Quality-of-Care Issue
Reintubation following unplanned extubation in critically ill post-operative patients is associated with increased hospital mortality. -
Dehydration Is a Poor Prognostic Sign in Acute Ischemic Stroke Patients
Dehydration is an independent predictor of discharge outcome and admission cost in acute ischaemic stroke. -
Nurse Practitioners and Physician Assistants in the ICU
Using retrospective cohort data from a national survey of medical and mixed medical-surgical ICUs, this study found that nurse practitioner (NP)/physician assistant (PA) staffing was common and not associated with any differences in in-hospital mortality compared to ICUs without NP/PAs. -
The Photosensitive Patient
A 65-year-old female presents to the emergency department with a chief complaint of a severe rash. The rash has been present for two weeks on her arms, neck, and scalp. It began while she was sitting on her porch one afternoon. She denies any associated fevers, chills, headache, or muscle ache. She denies any exposure to pets, new soaps, detergents, or lotions, and she denies recent travel.