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Although lower extremity fractures are much less common than upper extremity fractures in children, the correct diagnosis and management of this type of injury is critical. In the second part of this series the authors review common lower extremity fractures, fractures common in abused children and the diagnosis and treatment of radial head subluxation. Children are much more likely to sustain fractures rather than ligamentous injuries and identification of injuries and timely management will maximize an optimal outcome. Awareness of certain unique pediatric fractures such as the triplane juvenile fracture and the juvenile Tillaux fracture will allow for prompt treatment and referral. The authors also provide a table encompassing guidelines for ED management and treatment of common pediatric orthopedic injuries.
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In a prospective study of the actual oral nutritional intake of patients with respiratory failure in the first week following extubation, average intake failed to exceed 50% of daily requirements on all seven days.
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In this retrospective study of patients hospitalized because of severe chronic liver disease, venous thromboembolism was relatively common and "auto-anticoagulation" in the form of an elevated INR had no apparent protective effect.
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The use of angiotensin converting enzyme (ACE) inhibitors in all acute myocardial infarction (MI) patients is controversial. Thus, these investigators from the Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA) examined the association between ACE inhibitor therapy and mortality in unselected patients with acute MI.
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Serious infections caused by Acinetobacter baumannii are appearing in the community, spread by patients who acquired the organism in the hospital setting, and conversely, the organism is being introduced into the hospital from long-term nursing care patient settings. Resistance to antimicrobial agents has increased over the six-year study period, along with the severity of disease.
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Early antibiotic administration was associated with reduced likelihood of death, mechanical ventilation, and readmission (but increased risk of Clostridium difficile infection) among patients hospitalized for acute exacerbations of COPD.
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