Stroke
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Stroke Alert: A Review of Current Clinical Stroke Literature
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Thymectomy for Juvenile Myasthenia
Although never confirmed in a randomized clinical trial, thymectomy appears to be efficacious in children with antibody-positive myasthenia gravis. -
Levodopa-Carbidopa Intraintestinal Infusion: Benefits in Advanced Parkinson's Disease
In this 12-week, randomized, double-blind and double-dummy trial, intrajejunal infusion of levodopa-carbidopa gel decreased "off" time by almost 2 hours more than oral levodopa-carbidopa in individuals with Parkinson's disease suffering motor fluctuations. -
Practical Management of the Suicidal Patient in the Emergency Department
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. -
CME Instructions/Questions
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Obesity in Trauma Care
MONOGRAPH: The authors review the implications of obesity for acute care physicians who manage trauma.
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Family Presence During Pediatric Resuscitations and Invasive Procedures
ACEP, AAP, and several other prominent pediatric and critical care organizations have endorsed the practice of offering parents the choice about being present during invasive procedures and resuscitations. The majority of the literature supports providing the parents the choice to be able to remain with their children during procedures, including resuscitative efforts. There have also been psychological benefits with family members who remained present during resuscitations by lowering their anxiety and depression scores, having fewer disturbing memories, and lowering degrees of intrusive imagery and post-traumatic avoidance behavior. -
Massive Transfusion: Part II
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. -
Kawasaki Disease
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. -
Community paramedics fill gaps, take load off EDs
In a continuing effort to ease demand on busy EDs, some communities are coming up with new ways to leverage paramedics.