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Crisis management

Christina Schumann, Michael Faust
BACKGROUND:  Diabetic ketoacidosis and the hyperosmolar hyperglycemic state are the most serious diabetic emergencies. Before the discovery of insulin in 1921 by Banting and Best the diagnosis of type 1 diabetes was fatal ending in diabetic ketoacidosis equivalent to a torturous death. Today, mortality from diabetic ketoacidosis is low at approximately 2 %. But each death from these two acute metabolic complications of diabetes is potentially avoidable by improved patient and healthcare professional education...
March 2018: Deutsche Medizinische Wochenschrift
Karl Kim, Pradip Pant, Eric Yamashita
A recent lava flow in Puna, Hawaii, threatened to close one of the major highways serving the region. This article provides background information on the volcanic hazards and describes events, responses, and challenges associated with managing a complex, long-duration disaster. In addition to the need to better understand geologic hazards and threats, there is a need for timely information and effective response and recovery of transportation infrastructure. This requires coordination and sharing of information between scientists, emergency managers, transportation planners, government agencies, and community organizations...
January 2018: Journal of Emergency Management: JEM
Ali Bin Nadeem, Ysa Chandna
The majority of the Pakistani public has known little of the unmanned aerial vehicles, also known for their onomatopoeically inspired name "drones," except the fact that it regularly rains Hellfire missiles in Pakistan, claiming the lives of many innocent Pakistanis settled in the western provinces. In actuality, in addition to their destructive capacities, these remotely piloted vehicles have been used since the turn of the century in a variety of live-saving and risk-reducing roles. This research article primarily addresses the third stage of Emergency management-response, with Pakistan being the primary region of research...
January 2018: Journal of Emergency Management: JEM
James B Leonard, Kashif M Munir, Hong K Kim
Metoclopramide (MCP) is a commonly used anti-emetic in the emergency department (ED). Its use is generally well tolerated; although infrequent adverse reactions such as extrapyramidal reactions or tardive dyskinesia are reported. However, many ED providers are not familiar with the potentially life-threatening hypertensive emergency that can be precipitated by MCP administration in patients with pheochromocytoma. A previously healthy 36-year-old woman presented to the ED with headache and nausea. She developed acute hypertensive emergency (acute agitation, worsening headache, chest pain and wide complex tachycardia) when her blood pressure (BP) increased to 223/102mmHg (initial BP, 134/86mmHg) after receiving intravenous MCP...
March 5, 2018: American Journal of Emergency Medicine
Sangeeta Chattoo
This paper engages critically with the global assemblage framing sickle cell and thalassaemia disorders as a 'global health crisis'; and the promise of genomics, largely DNA-based carrier/pre-conceptual screening, prenatal diagnosis with a view to terminations, deployed in framing a solution to these historically racialised spectrum of diseases as essentially preventable. Sickle cell and thalassaemia are recessively inherited, potentially life-threatening haemoglobin disorders with significant variation of severity, often needing life-long treatment...
April 2018: Anthropology & Medicine
C Feeney, K G Buell, P Avari, A Buckley, K Meeran, D A Rees
No abstract text is available yet for this article.
March 2, 2018: British Journal of Hospital Medicine
Jinglan Zhang, Jiakai Lu, Xiaorui Zhou, Xuefeng Xu, Qing Ye, Qitan Ou, Yanna Li, Jiapeng Huang
OBJECTIVES: The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China...
March 7, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Ana Margarida Monteiro, Olinda Marques, Sofia Martins, Ana Antunes
The authors report a case of a 15-year-old girl with hypopituitarism due to pituitary stalk interruption syndrome diagnosed in the neonatal period. The patient was admitted to the emergency room with impaired consciousness and hypoglycaemia. The day before, she increased her water intake to about 1.5 L to perform a pelvic ultrasound. In the following hours, she developed vomiting and food refusal. Blood analysis revealed hypoglycaemia, hyponatraemia, decreased serum osmolality and normal urinary density. Hyponatraemia and adrenal crisis were managed with a gradual but slow resolution of consciousness and electrolytic balance...
March 9, 2018: BMJ Case Reports
Ahmed Subahi, Walid Ibrahim, Ashraf Abugroun
CLINICAL FEATURES: The patient we present is a 39-year-old woman with a history of hyperthyroidism who developed fast atrial fibrillation secondary to thyrotoxic storm. After the initiation of intravenous diltiazem drip, she developed hypotension, bradycardia, then asystole cardiac arrest. THERAPEUTIC CHALLENGE: It is well known that calcium channel blockers and beta blockers should be used with extreme caution if the patient with thyroid storm has decompensated heart failure with reduced ejection fraction...
February 28, 2018: American Journal of Therapeutics
Michail Sideris, John Hanrahan, Georgios Tsoulfas, Iakovos Theodoulou, Fatema Dhaif, Vassilios Papalois, Savvas Papagrigoriadis, George Velmahos, Patricia Turner, Apostolos Papalois
BACKGROUND: Essential Skills in the Management of Surgical Cases (ESMSC) is a novel 3-day international undergraduate surgical masterclass. Its current curriculum (Cores integrated for Research-Ci4R) is built on a tetracore, multiclustered architecture combining high-fidelity and low-fidelity simulation-based learning (SBL), with applied and basic science case-based workshops, and non-technical skills modules. We aimed to report our experience in setting up ESMSC during the global financial crisis...
March 8, 2018: Postgraduate Medical Journal
Taffy Makaya, Jennifer Gilbert, Fiona Ryan, Wendy Watts
Clinical governance processes are important for improving patient care. Patients with adrenal insufficiency are at significant risk if they have an adrenal crisis and require steroid therapy. Families should receive education on managing illness or stress, that is, steroid sick day rules. Most of this education is delivered by children's nurses. Two local cases of mortality related to adrenal insufficiency were reviewed and a questionnaire audit was undertaken to compare the steroid sick day rules education provided to patients and their families with published standards...
March 7, 2018: Nursing Children and Young People
Fabrizio Bracco, Gabriele de Tonetti, Michele Masini, Marcello Passarelli, Francesca Geretto, Danilo Celleno
Human factors are the most relevant issues contributing to adverse events in obstetrics. Specific training of Crisis Resource Management (CRM) skills (i.e., problem solving and team management, resource allocation, awareness of environment, and dynamic decision-making) is now widespread and is often based on High Fidelity Simulation. In order to be used as a guideline in simulated scenarios, CRM skills need to be mapped to specific and observable behavioral markers. For this purpose, we developed a set of observable behaviors related to the main elements of CRM in the delivery room...
March 3, 2018: International Journal of Environmental Research and Public Health
Eric M Plakun
This column compares a clinical perspective on the continuum of care for mental health and substance use disorders with a different perspective derived from publicly available insurance company documents and experience dealing with managed care utilization reviewers. The latter perspective tends to determine the need for access to levels of care based on the need for crisis stabilization, whereas the generally accepted clinical standard is more nuanced than the need for crisis stabilization alone. The column proposes that this discrepancy in perspectives makes a substantial contribution to disagreements between treating clinicians, such as therapists, and insurance utilization reviewers concerning the medical necessity of various requested levels of care...
March 2018: Journal of Psychiatric Practice
Judith A Paice
Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief...
March 2, 2018: Cancer
(no author information available yet)
The potential for a veterinary capacity crisis after Brexit was highlighted at BVA's recent lobbying dinner in London. Helena Cotton , BVA Public Affairs Manager, reports.
March 3, 2018: Veterinary Record
Milan Talwar, Sriram Krishnamurthy, Narayanan Parameswaran, C G Delhikumar, Satish Haridasan, Bheemanathi Hanuman Srinivas
Glucose-6-phosphate dehydrogenase (G6PD) deficiency leading to acute intravascular haemolysis and acute kidney injury (AKI) is a known clinical presentation. However, there is a paucity of information regarding the occurrence of rhabdomyolysis and myoglobinuria in G6PD-deficient individuals, especially children. An 11-year-old south Indian Tamil girl presented with severe anaemia and anuric AKI following a short febrile illness. Investigations demonstrated evidence of intravascular haemolysis and rhabdomyolysis, and on histopathology myoglobin deposits (casts) were detected in the renal tubules...
March 1, 2018: Paediatrics and International Child Health
Margaret E Balfour, Tylar E Zinn, Karena Cason, Jerimya Fox, Myra Morales, Cesar Berdeja, Jay Gray
The authors describe a quality improvement approach in which a crisis center and a payer collaborate to improve care. Each crisis visit is considered as a potentially missed opportunity for community stabilization. Daily data on crisis visits are sent to the payer for a more up-to-date analysis of trends than is possible with financial claims data, which may lag behind services provided by up to 90 days. Using these trend data, the two organizations collaborate to identify patterns that lead to opportunities for improvement and develop multiple rapid-cycle projects for better management of services, resulting in significant decreases in readmissions and in the number of high utilizers...
March 1, 2018: Psychiatric Services: a Journal of the American Psychiatric Association
Chris Allen, Ivaylo Vassilev, Sharon Xiaowen Lin, David Culliford, Anne Rogers
Objectives To describe the individual and network characteristics of the personal communities of people using the internet and the role of offline support, network resources and community participation in using the internet for condition management. Methods Secondary analysis of survey data using logistic regression analysis to determine the factors associated with differential internet use for condition management. This study involved 300 participants from 19 primary care providers in Manchester in 2010 and 2011...
January 1, 2018: Chronic Illness
Olaf Eberhardt
The urgency and intensity of therapeutic response to a hypertensive crisis are governed by the presence or absence of acute end-organ damage, which define hypertensive emergency and hypertensive urgency, respectively. In case of hypertensive urgency a slow and moderate lowering of blood pressure by oral antihypertensive agents seems adequate, while the approach to hypertensive emergency has to be tailored to the specific type of organ failure. Optimal blood pressure management in the context of neurovascular emergencies is made difficult by contradictory data from observational and interventional studies...
February 28, 2018: Fortschritte der Neurologie-Psychiatrie
Ellen M Raney, Harold J P van Bosse, Kevin G Shea, Joshua M Abzug, Richard M Schwend
INTRODUCTION: The opioid epidemic in the United States has reached crisis proportions. Urgent response is needed. Hydrocodone in combination with acetaminophen is the most prescribed drug in the United States. The most common source of opioids available for misuse is the unused portions of postoperative prescriptions. Among high school seniors, 80% of those who reported nonmedical use of prescription opioids previously had legitimate prescriptions but recreationally used leftover doses...
February 27, 2018: Journal of Pediatric Orthopedics
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