A Nefarious Character with an Agenda
Every new advanced nurse practitioner, physician assistant, or resident gets his fair share of complex emergency department procedures during training. Seasoned providers, however, are just as excited to place a central line in a septic patient, LP a "rule-out meningitis," or swiftly fix a nursemaid's elbow.This month we hope to remind you of a few sweet and satisfying procedures that take only moments to do. Your skill in completing these procedures is imperative. Not only will you amaze your patient, but you'll shorten your door to dispo-time.The StyeThe stye is a nefarious character with an agenda. It starts off by slowly enlarging over the patient's lid, and it can consume other portions of the face if not treated appropriately. Patients may present to the ED on the fifth day or later when the enlarged lid starts to impair their vision. Occasionally, patients have associated facial swelling, tenderness, or even a preseptal cellulitis. Distinguishing the signs of these complications is imperative for proper treatment. It may be difficult to discern the emergent eye from the urgent eye from the "it-can-wait" eye. You will feel confident about draining an eye lid abscess after reading this post, and you can add one more magic ace to your deck. The ApproachIdentification of stye (or hordeolum)Evert the lid to look for the pus collectionIf pus is readily seen, incision and drainage of styeCorrect outpatient treatments and aidesOphthalmology follow-upTh...
What are the latest strategies for fertility preservation in adolescent and young adult survivors of childhood cancer?Current Opinion in Urology
ConclusionsExtra-pelvic endometriosis, traditionally thought to be rare, have been reported in a considerable number of cases. Heightened awareness and clinical suspicion of the disease, and multi-disciplinary approach is recommended to achieve prompt diagnosis and optimize patient outcomes. At this time, there are no comparative studies to provide recommendations regarding optimal diagnostic methods, treatment options and outcomes for endometriosis involving extra-pelvic sites.
ConclusionsGVS appeared as a well-tolerated and powerful procedure for the relief of experimental pain, probably through physiological interaction within insular nociceptive networks. Either isolated or in combination with other types of vestibular activation (e.g., optokinetic stimuli), GVS deserves being tested in clinical settings.
ConclusionThe twin block is effective in the long-term management of masticatory myofascial pain as compared to trigger point injections.Trial RegistrationClinicalTrials.gov Identifier: NCT03870191
ConclusionNeedle flexor tenotomies are a relatively safe and effective treatment compared to tenotomies done by scalpel, both as treatment for ulcers and to prevent formation of new ulcers associated with hammer, mallet and claw toe deformities. As a side note, transfer complications are avoidable if all toes on one or both feet are tenotomized in one procedure.
ConclusionOur study showed a significant association between alterations in intestinal microbial composition and T1D; however, in some articles, it is not clear which one happens first. Investigation of altered gut microbiota can help in the early detection of T1D before seropositivity. Targeted microbiome modulation can be a novel potential therapeutic strategy.
Conclusions: The DC-TAV program is an ambitious, civilian-military, nationwide and long-term program, based on a harmonised standard of care and including multidimensional training. Further studies are required to assess its efficacy.
Publication date: Available online 12 October 2019Source: Anaesthesia Critical Care &Pain MedicineAuthor(s): Arnaud Chaumeron, Jeremie Castanie, Louis Philippe Fortier, Patrick Basset, Sophie Bastide, Sandrine Alonso, Jean-Yves Lefrant, Philippe CuvillonABSTRACTBackground: Rapid sequence induction (RSI) is recommended in patients at risk of aspiration, but induced hemodynamic adverse events, including tachycardia. In elderly patients, this trial aimed to assess the impact of the addition of remifentanil during RSI on the occurrence of: tachycardia (primary outcome), hypertension (due to intubation) nor hypotension (rem...
Publication date: Available online 13 October 2019Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Yuichi Ohgoshi, Yosuke Usui, Satoshi Terada, Yoshimasa Takeda, Aiji Ohtsuka
ConclusionsThis case series demonstrates that the use of a high frequency jet ventilator for cardiac MRI was feasible, safe, providing good quality cardiac imaging and avoiding anesthesia personnel to be inside the hazardous environment of MRI room. Future studies are needed to confirm its safety and efficiency in pediatric patients.ResumoJustificativa e objetivosA ressonância magnética (RM) cardíaca é uma técnica utilizada na avaliação de crianças com cardiopatias congênitas. A anestesia geral garante imobilidade, especialmente em pacientes não cooperador...
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