special considerations in pediatric emergency care

... portacaval shunting, thereby decreasing first pass metabolism; decrease in quantities and affinity of plasma proteins, thereby increasing free-drug levels; increase in volume of distribution in patients ... guidelines are being formulated to aid clinicians in identifying patients at risk Screening for diabetes should include questioning patients about symptoms such as excessive thirst and urination, ... studied primarily in patients with seizure disorders Carbamazepine-induced increase in total cholesterol is primarily due to an increase in HDL [34] This occurs during the initial weeks of therapy,...

Ngày tải lên: 25/10/2012, 10:51

... and reliable clinical decision rule for CT use in children with minor head injury We are going to examine the clinical impact and costs of implementing this CT head rule in both pediatric and ... Despite the heightened interest in clinical guidelines, there remains much uncertainty about how best to introduce them into routine practice [9-11], partially due to the varying effectiveness of ... the use of the CATCH rule at the intervention sites This includes educational initiatives, mandatory online reminders, and attaining physician agreement in ordering CT scans by the CATCH rule Proposed...

Ngày tải lên: 11/08/2014, 05:21

... and reliable clinical decision rule for CT use in children with minor head injury We are going to examine the clinical impact and costs of implementing this CT head rule in both pediatric and ... Despite the heightened interest in clinical guidelines, there remains much uncertainty about how best to introduce them into routine practice [9-11], partially due to the varying effectiveness of ... the use of the CATCH rule at the intervention sites This includes educational initiatives, mandatory online reminders, and attaining physician agreement in ordering CT scans by the CATCH rule Proposed...

Ngày tải lên: 11/08/2014, 16:20

... recognized by leaders in paediatric intensive care and incorporated into the daily routines of the PICU Caring for children in the PICU also involves responding to the needs of dying patients It is ... humanistic culture in critical care where several disciplines with differing opinions and agendas may be involved in caring for a critically ill child For example, in a PICU many disciplines (pulmonology, ... leaders in critical care engage in mindful practice, we can then lead others to adopt these principles Mindfulness is a discipline and an attitude of mind The goal of mindfulness is compassionate informed...

Ngày tải lên: 12/08/2014, 22:21

Ngày tải lên: 13/08/2014, 20:21

... approach, all (6/6) indicated they may use insulin infusions for glycemic control, while some also attempt to manage hyperglycemia using intermittent insulin (subcutaneous or intravenous) and/or ... disciplines As such, even in the absence of direct evidence of improved outcomes with glycemic control in pediatric critical care, there may be good reason for pediatric groups interested in providing ... to instituting routine glycemic control in their pediatric ICU Indeed, studies in adult ICUs regarding glycemic control report hypoglycemic (BG

Ngày tải lên: 13/08/2014, 20:21

... colleagues demonstrated in two studies the clinical usefulness of lymphocytopenia in predicting bacteremia in patients with emergency medical admissions, meriting further investigation into this topic ... of the NLCR in predicting survival after coronary artery bypass grafting and chronic heart failure [15-18,20] The NLCR is a potentially interesting parameter in predicting bacteremia in patients ... discriminatory capacity in predicting bacteremia in infectious emergency admissions Page of Limitations As this is a derivation study the true value of lymphocytopenia and the NLCR in predicting...

Ngày tải lên: 13/08/2014, 21:21

... 36 37 38 39 Hunink M, Glasziou P, Siegel P, Weeks J, Pliskin J, Elstein A, Weinstein M: Decision making in health and medicine: integrating evidence and values In vol Fourth printing, 2005 Cambridge ... discriminators are related to the presenting problems such as 'Increased work of breathing' (flowchart 'Shortness of breath in children') or 'Persistent vomiting' (flowchart 'Abdominal pain in children') ... within 60 minutes for level 3, within 120 minutes for level and within 240 minutes for level A second version of the MTS was published by the Manchester Triage group in 2006 [5] Some discriminators...

Ngày tải lên: 13/08/2014, 23:20

... Antihistamines Antihistamines are a mainstay in treatment of allergic rhinitis The first-generation or "older" antihistamines (e.g., chlorpheniramine, diphenhydramine) are effective in reducing sneezing, ... useful in reducing sneezing, itching, congestion, and rhinorrhea and are extremely safe in the elderly They can be divided into nonsteroidal agents (cromolyn, azelastine and olopatadine) and corticosteroids ... also been shown to result in rhinitis Types of Rhinitis in the Elderly • Allergic Nonallergic rhinitis with eosinophilia (NARES) NARES is characterized by eosinophil infiltration of nasal tissue...

Ngày tải lên: 08/08/2014, 21:20

... the ED was infrequent Many physicians who worked on a part-time basis were family physicians or pediatricians without specialty training in emergency medicine, and were perceived as being less ... current Interestingly, clinical practice variation was tolerated to different degrees among the nine sites High staff turnover in the PEDs resulted in difficulty in following up on practice change initiatives ... site In two of the three early adopting sites, leadership at the clinical level was instrumental in achieving 'buy -in' by staff, and subsequently, adoption Buy -in was achieved by providing both...

Ngày tải lên: 11/08/2014, 05:21

... the ED was infrequent Many physicians who worked on a part-time basis were family physicians or pediatricians without specialty training in emergency medicine, and were perceived as being less ... current Interestingly, clinical practice variation was tolerated to different degrees among the nine sites High staff turnover in the PEDs resulted in difficulty in following up on practice change initiatives ... site In two of the three early adopting sites, leadership at the clinical level was instrumental in achieving 'buy -in' by staff, and subsequently, adoption Buy -in was achieved by providing both...

Ngày tải lên: 11/08/2014, 16:20

... stress in parents of children admitted to the pediatric intensive care unit Pediatric Critical Care Medicine 2004, 5:547-553 Board R, Ryan-Wenger N: Long-term effects of pediatric intensive care ... mental health outcome Helping parents manage the PICU period by regaining perceived control might be effective in reducing these outcomes (e.g involve parents in the care for the child) Some limitations ... up Intensive and Critical Care Nursing 2006, 22:49-55 Rees G, Gledhill J, Garralda ME, Nadel S: Psychiatric outcome following pediatric intensive care unit (PICU) admission: a cohort study Intensive...

Ngày tải lên: 13/08/2014, 18:21

... Published: 10 September 2011 References Price CP: Point of care testing BMJ 2001, 322:1285-1288 Fermann GJ, Suyama J: Point of care testing in the emergency department J Emerg Med 2002, 22:393-404 ... Analytical and clinical validation of a new point-of -care testing system for determination of D-Dimer in human blood Thromb Res 2010, 524-530 12 Renaud B, Maison P, Ngako A, Cunin P, Santin A, Herve ... Analytical and clinical validation of a new point-of -care testing system for determination of D-Dimer in human blood Thromb Res 2010, 126:524-530 Hedberg P, Wennecke G: A preliminary evaluation...

Ngày tải lên: 13/08/2014, 23:20

... catheters were inserted in 99/178 patients (55.6%) with 14.1% (14/99) inserted in the ED and 71.7% (71/99) inserted in the first hours of ICU admission Chest tubes insertion was completed in a minority ... critically ill patients in the ED is incomplete The primary objective of this study is to determine the length of stay of critically ill patients receiving care in a tertiary care adult emergency department ... relatively few patients underwent invasive procedures such as CVC or AC insertion in the ED In addition, invasive procedures not performed in the ED were often performed early in the ICU admission Other...

Ngày tải lên: 13/08/2014, 23:20

... clinicians who are involved in the care of pediatric and adult congenital cardiac patients Learning Objectives • Gain an understanding of the latest developments and techniques in neonatal, pediatric, ... participation in the activity Nursing Continuing Education Credits The NewYork-Presbyterian Hospital School of Continuing Education for Nurses is an approved provider of continuing nursing education ... Current Concepts in Pediatric and Adult Congenital Cardiac Critical Care Introduction This one-day educational symposium will focus on the innovations in the care of pediatric and adult...

Ngày tải lên: 14/12/2015, 20:33

... most important thing is to maintain the shape of the fruit Use apple, potato, tomato, plum, ginger, mandarin, or gourd Apple: Pierce skin lengthwise, but don’t cut too deep Place in a bowl of cold ... overnight Wash carefully and dry Cover in red sugar Stir very carefully in a dry pan over low heat until sugar melts and solidifies Take off heat Press down carefully on top of apple to make into shape ... out after piercing skin Last, but not least After indulging in all the above, remember that you cannot throw out any leftovers until the fourth day of Tet It would also be highly inauspicious to...

Ngày tải lên: 19/10/2012, 14:57

... understanding of AF in critically ill patients Competing interests The authors declare that they have no competing interests References Pinski SL: Atrial fibrillation in the surgical intensive care ... tachyarrhythmias, in particular atrial fibrillation, in surgical intensive care patients Crit Care Med 2003, 31:401-405 84 Donovan KD, Hockings BE: Shocking? Crit Care Med 2003, 31: 639-640 85 Dunning J: ... Malledant Y: Atrial fibrillation in trauma patients requiring intensive care Intensive Care Med 2006, 32:398-404 11 Seguin P, Signouret T, Laviolle B, Branger B, Malledant Y: Incidence and risk factors...

Ngày tải lên: 25/10/2012, 10:35

... medications discontinued in the ABC trial, thereby resulting in a blunted stress response during sedation interruption and minimizing the symptoms of withdrawal during sedation interruption [32] ... (Table 3) Sedation interruption In the DIS group, assessments were made for sedation interruption on 173 occasions In 92% of the cases, patients were receiving continuous infusions; in 4% of the cases, ... nursing staff underwent a 2-month introductory period in the use of the algorithm After educational training, the algorithm underwent a 1-month run -in period prior to study initiation During...

Ngày tải lên: 25/10/2012, 10:35

... Minor errors were classified as those causing no harm or an increase in patient monitoring with no change in vital signs and no harm noted Moderate errors were classified as those causing an increase ... scores are given in Tables and Most of the errors were minor in outcome, although two non-intercepted errors with CPOE led to an increased length of stay or increased monitoring In the first case, ... prescribing existed specifying the tenets of good practice, including the avoidance of the use of abbreviations An ME was defined to have occurred when a prescribing decision or prescription writing...

Ngày tải lên: 25/10/2012, 10:39

... intensive care and general care units Crit Care Med 1997, 25:1289-1297 12 Herout PM, Erstad BL: Medication errors involving continuously infused medications in a surgical intensive care unit Crit Care ... beta-blocker, where rapid intervention of the clinical pharmacist intercepted the administration of this overdose The nonintercepted potential ADEs were mainly dosing errors or incompleteness of low ... had to order a 'vancomycin loading dose' and a 'vancomycin dose according to plasma level', without having to adjust anything, which virtually eliminates the risk of making errors Page of (page...

Ngày tải lên: 25/10/2012, 10:39