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Beta-blockers and noncardiac surgery; prenatal medication exposure and risk of autism; reasons for statin discontinuations; and FDA actions.
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Asthma is a common problem in the emergency department (ED), with many children having significant exacerbations. The ED physician must be prepared with a versatile approach to rapidly stabilize the patient. This article comprehensively reviews the approach to a child with acute severe asthma, emphasizing management alternatives.
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Nationwide from 2000-2009, there was a steady increase in the use of noninvasive ventilation (NIV) in managing acute respiratory failure, although the percentage of potentially eligible patients who receive it remains small. Importantly, the proportional increase was less for chronic obstructive pulmonary disease ([COPD] in which the evidence is compelling and NIV is the standard of care) than for non-COPD causes of respiratory failure (in which the evidence is weaker or conflicting).
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Using a national database, the authors found that morbidly obese patients undergoing invasive mechanical ventilation had a similar risk of in-hospital mortality compared to non-obese individuals, despite having higher rates of invasive mechanical ventilation and tracheostomy.
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Deep sedation during the early period of mechanical ventilatory support delays extubation and increases mortality, yet is a modifiable risk factor that requires innovative intervention to reduce these adverse outcomes.
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Scaphoid fractures are by far the most frequent bony injuries of the wrist in both pediatric and adult patients. The peak incidence is in adolescence, around 15 years of age.
Skiers thumb is an acute injury to the ulnar collateral ligament (UCL) caused by forced abduction and hyperextension of the thumb; frequently it is associated with any sport that involves grasping a pole, such as skiing, hockey, lacrosse, or pole vaulting.
Bennett fractures are fractures of the first metacarpal, with the fracture line extending from the base of the metacarpal (MC) to the CMC joint. Bennett fractures are the most common thumb MC fractures. Involvement of the CMC makes this fracture unstable.
A Rolando fracture is defined as a comminuted fracture of the base of the thumb metacarpal. The mechanism of a Rolando fracture is most often simultaneous hyperextension and hyperabduction. This fracture type is typically unstable and occurs less commonly than a Bennett fracture in the pediatric population.
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The purpose of this article is to review procedures and therapies used in the difficult, life-threatening clinical circumstances. The authors review five procedures that are rarely used in extreme situations.
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