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Patient safety team of the year

Improving patient safety is a never ending quest. The shortlist for The BMJ Award for Patient Safety Team exemplifies how varied are the ways in which safety can be improved and outcomes bettered, says Nigel Hawkes. Two projects sought to enhance medical skills at the bedside to detect the deteriorating patient, two to reduce risks associated with innovation in treatments and in drug dispensing, and one to improve care of broken hip, a common misadventure of elderly people that too often leads to death.  
feeds.bmj.com
over 5 years ago
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3

Patient safety team of the year

Improving patient safety is a never ending quest. The shortlist for The BMJ Award for Patient Safety Team exemplifies how varied are the ways in which safety can be improved and outcomes bettered, says Nigel Hawkes. Two projects sought to enhance medical skills at the bedside to detect the deteriorating patient, two to reduce risks associated with innovation in treatments and in drug dispensing, and one to improve care of broken hip, a common misadventure of elderly people that too often leads to death.  
feeds.bmj.com
over 5 years ago
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Journal club: Raised glucose levels predict death for patients with pneumonia

Stream Journal club: Raised glucose levels predict death for patients with pneumonia by BMJ talk medicine from desktop or your mobile device  
feeds.bmj.com
over 5 years ago
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9

Dinitrophenol Overdose | Resus Review

Dinitrophenol is promoted for helping weight loss, but is toxic drug causing hyperthermia, mental status changes, organ failure, and death.  
resusreview.com
over 5 years ago
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The Respiratory Death Airway Algorithm

0 Introduction 0 Last week Scott Weingart discussed a case of a profoundly hypoxemic patient with a failed airway which was salvaged by surgical cricothyro  
pulmcrit.org
over 5 years ago
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15

Cadaver Workshop at SMACC Chicago - Intensive Care Network

A new announcement for SMACC Chicago - a Cadaver workshop for procedural skills. Incredible discounted price, but not many places, so book ASAP.  
intensivecarenetwork.com
over 5 years ago
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Hypothermia and Drowning Pearls - emdocs

Winter is coming...well maybe not yet, but you never know when you will see your next drowning or hypothermic patient will enter your ED, so be prepared!  
emdocs.net
over 5 years ago
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KT Evidence Bite: Rapid blood pressure lowering in intracerebral hemorrhage - CanadiEM

Rapid blood pressure lowering to intensive or standard targets in a multicenter, randomized controlled trial showed no difference in death or major  
boringem.org
over 5 years ago
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The Case of the Balanced Solution - EM Nerd

Saline-based resuscitation strategies were first proposed as far back as 1831 during the Cholera Epidemic. In an article published in the Lancet in 1831, Dr. O’Shaughnessy suggests the use of injected salts into the venous system as a means of combating the dramatic dehydration seen in patients afflicted with this bacterial infection(1). Saline’s potential harms were first observed in post-surgical patients who after receiving large volumes of saline based resuscitation fluids during surgery were found to have a hyperchloremic acidosis (2). Though these changes appear transient and clinically trivial, it is theorized that when applied to the critically ill, the deleterious effects on renal blood flow may increase the rate of permanent renal impairment and even death. Unfortunately, no large prospective trials have demonstrated this hypothesis to be anything more than physiological reasoning. Small prospective trials have exhibited trivial trends in decreased renal blood flow, kidney function, and increased acidosis, though these perturbations were fleeting and of questionable clinical relevance (3, 4, 5, 6, 7). A larger retrospective study, bringing all the biases such trials are known to carry, demonstrated small improvements in mortality of ICU patients treated with a balanced fluid strategy, though it failed to demonstrate improvements in renal function (the theoretical model used to support balanced fluid administration) (8). In 2012 Yonus et al were the first to attempt to prospectively answer this question in an ICU population. Published in JAMA, on first glance the results seemed to vindicate those in support of the use of balanced fluids (9). Yet despite its superficial success, a closer look reveals this trial does little to demonstrate the deleterious effects of chloride-rich resuscitative strategies. In a recent publication in Intensive Care Medicine, Yonus et al re-examine this question in the hopes of once again demonstrating the benefits of balanced fluid strategies for the resuscitation of the critically ill (10).  
emnerd.com
over 5 years ago
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A Case of Identity Part Two - EM Nerd

Our standards for acceptable benefit of antiplatelet agents in the management of ACS have become deplorably low. When ISIS-2 was first published we defined success only by aspirin’s ability to affect mortality. The number commonly cited, 2.4%, only describes aspirin’s absolute benefit to decrease death (1). In the one trial that examined its properties to prevent further infarction, published in the NEJM in 1988, aspirin demonstrated additional capabilities to decrease myocardial infarction as well as save lives (2). If in ISIS-2, aspirin had performed as poorly as clopidogrel did in its efficacy defining study, the CURE trial, it may have never gained the stature it currently holds in the management of ACS (3). To date aspirin has been the only antiplatelet agent that has demonstrated a consistent and clinically relevant mortality benefit. Despite the obvious benefits, it was not long before we turned towards other agents in an attempt to supplement aspirin’s antiplatelet properties. The concept of dual antiplatelet therapy so appealing, its theoretical basis so believable, it soon became a perfunctory part of our management strategy for patients presenting to the Emergency Department with ACS.  
emnerd.com
over 5 years ago
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Planned early delivery versus expectant management for twins who are in the same amniotic sac during pregnancy (monoamniotic twins) | Cochrane

Monoamniotic twin pregnancies are rare and affect about one in 10,000 pregnancies. These pregnancies are more susceptible to complications such as increased congenital abnormalities, intrauterine growth restriction, twin-to-twin transfusion syndrome, cord entanglement and possible occlusion, which may lead to an increased risk of fetal and infant death compared with other kinds of twin pregnancies. The optimal timing for the birth of monoamniotic twins is not known. Options include 'planned early delivery' between 32 and 34 weeks, or alternatively awaiting spontaneous labour at least up until the usual time of planned delivery for other monochorionic twins (approximately 36 to 38 weeks' gestation), unless there is a specific indication for earlier delivery.  
cochrane.org
over 5 years ago
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'White collar' boxer death caused by diet drugs - BBC News

The death of a boxer who collapsed after a "white collar" match was partly caused by a fat burning drug, an inquest concludes.  
bbc.co.uk
over 5 years ago
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Obesity 'was a factor' in death of 18 year old - BBC News

Satish Appleby speaks about the death of her overweight son.  
bbc.co.uk
over 5 years ago
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Digoxin is linked to raised risk of death in patients with atrial fibrillation

Digoxin is associated with increased mortality in patients treated for atrial fibrillation or heart failure, the largest meta-analysis to review this treatment has concluded. The researchers warned that digoxin should be used with great caution and that patients’ plasma levels should be monitored until randomised controlled trials are carried out.  
feeds.bmj.com
over 5 years ago
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Sustained statin use is associated with lower risk of death in lung cancer patients, study shows

Patients with lung cancer who have had more than 12 prescriptions for statins after their cancer diagnosis have a significantly lower risk of death from the disease than lung cancer patients who don’t take these commonly prescribed drugs, concludes a study that researchers say supports further investigation into the use of statins as adjuvant cancer therapy.  
feeds.bmj.com
over 5 years ago
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Critical Care

The Surviving Sepsis Campaign [1] advocates maintaining a mean arterial pressure (MAP) of at least 65 mm Hg in sepsis patients undergoing resuscitation. Leone and colleagues [2], in an article published in this journal, suggest considering higher MAP targets in the resuscitation of patients with a history of arterial hypertension so they do not progress to acute kidney injury. Asfar and colleagues [3], in a multicenter, open-label trial, showed no significant difference in mortality outcomes in septic shock patients undergoing resuscitation with an MAP target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). However, the study did show that chronic hypertensive patients in the higher-target group had lower incidences of acute kidney injury and renal replacement therapy. This likely stems from the need for higher MAPs in chronic hypertensive patients in order to maintain organ blood flow because of a shift of the organ’s autoregulatory range to the right. Thus, targeting a higher MAP for chronic hypertensive patients may help avoid the development of acute kidney injury and the need for renal replacement therapy. Renal replacement therapy carries with it inherent morbidity as well as additional cost. These costs include the need for dialysate fluid and extra personnel and the use of anticoagulation and the extracorporeal circuit [2]. However, chronic hypertensive patients in the high-target group had a greater incidence of new-onset atrial fibrillation (5.2% in the low-target group versus 9% in the high-target group). Patients with new-onset atrial fibrillation during sepsis have been shown to have increased incidences of in-hospital stroke and in-hospital mortality [4] as well as subsequent recurrence of atrial fibrillation and increased long-term risks for heart failure, ischemic stroke, and death [5]. This may offset any benefit of a higher MAP. The ideal target MAP may have to be individualized for specific patient populations. More studies are needed to determine whether baseline blood pressure plays a role in the ultimate determination of the ideal MAP target for patients with sepsis.  
ccforum.com
over 5 years ago
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Critical Care

Acute Kidney Injury (AKI) is common in critical ill populations and its association with high short-term mortality is well established. However, long-term risks of death and renal dysfunction are poorly understood and few studies exclude patients with pre-existing renal disease, meaning outcome for de novo AKI has been difficult to elicit. We aimed to compare the long-term risk of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD) and mortality in critically ill patients with and without severe de novo AKI.  
ccforum.com
over 5 years ago
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Lab Case 56 – Interpretation

<10%  Background level in smoker 10%     mild H 20%     dizziness, N, dyspnoea, throbbing headache 30%     Vertigo, ataxia, visual disturbance 40%     confusion, coma, seizures, syncope 50%     CVS, Respiratory failure, arrhythmia, seizures, death  
emergucate.com
over 5 years ago
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Flu vaccines for preventing cardiovascular disease | Cochrane

Flu infection may make cardiovascular disease (e.g. heart attack, stroke) and associated death more likely, and flu vaccination may reduce this risk. We included randomised studies comparing people receiving flu vaccine with those receiving no vaccine (placebo or no treatment). For this review update, we found eight trials studying 12,029 participants. Four of these studies examined patients with known heart disease (1682 participants), and the other four focused on the general population or elderly people (10,347 participants). The general population studies reported cardiovascular disease outcomes as part of their safety analyses, but the numbers of cases were too few to allow a judgement on whether flu vaccination was protective in these populations, and no differences were seen between groups. Overall, studies in people with heart disease suggest that flu vaccination may reduce death as a result of cardiovascular disease and may reduce combined cardiovascular disease events (such as heart attacks, strokes, necessity for bypass operations, etc.). However, these studies were small and had some risk of bias, so larger studies of better quality are needed to confirm the results.  
cochrane.org
over 5 years ago