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Recently The Joint Commission created a new standard, which calls for the identification of ED patients who are suicidal. This is based, in part, on the fact that a significant proportion of patients who die by suicide are seen in the ED in the months prior to their suicide. However, many of these patients are seen for non-mental health reasons.
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Kawasaki disease, first described by Dr. Tomisaku Kawasaki in 1967, is a self-limited systemic inflammatory vasculitis characterized by fever and a variety of mucocutaneous manifestations. Surpassing rheumatic heart disease, it is now the leading cause of acquired cardiac disease in children.
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There are several relatively new adjuvant treatments for patients with massive hemorrhage. Of these, TXA is most widely recommended. It is inexpensive and has been shown to reduce mortality when given within three hours of injury.
A new test, viscoelastic hemostatic assay, identifies the patient's stage of coagulability and fibrinogen status. The result of the test is a curve, which can help determine the need for fibrinogen, clotting factors, and platelets.
Massive transfusion is an independent predictor of increased mortality, increased infection rate, SIRS, andmulti-organ failure.
Complications of massive transfusion include acid/base derangement, electrolyte abnormalities (particularly hyperkalemia with rapid infusion), immune system changes, acute lung injury, and fluid overload.
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Patients with chronic kidney disease, acute myocardial infarction and atrial fibrillation and treated with warfarin had a lower risk for death, MI and ischemic stroke without a higher risk of bleeding.
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Effective cardiopulmonary resuscitation (CPR) is partly dependent on the adequacy of manual chest compressions, but they are limited by interruptions and less than ideal conditions such as during transport. Mechanical chest compression devices have been developed that improve organ perfusion vs manual compressions in experimental studies, but there is little evidence of their clinical effectiveness and safety compared to manual compressions.
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A systematic review and meta-analysis found that the healthcare-associated pneumonia concept was based on low-quality evidence confounded by publication bias and does not accurately identify antibiotic-resistant pathogens.
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Implementation of an evidence-based extubation-readiness bundle was associated with a decrease in mechanical ventilation days and pneumonia in brain-injured patients.
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At this time, ventricular fibrillation (VF) early after acute myocardial infarction (MI) is not an indication alone for an implantable cardioverter-defibrillator (ICD) therapy. However, there is concern that despite the efficacy of mechanical and pharmacological therapy for acute MI, the risk of subsequent sudden cardiac death (SCD) in patients with VF complicating acute MI may be higher and the guidelines should be revisited.
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