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Haemorrhagic management

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https://www.readbyqxmd.com/read/29326831/management-of-complications-in-anticoagulated-patients-with-atrial-fibrillation
#1
George D Katritsis, Demosthenes G Katritsis
Oral anticoagulation is mandatory for patients at high risk of thromboembolism, but the risk of bleeding should also be taken into account. Direct oral anticoagulants are now recommended for non-valvular AF as a potential alternative to warfarin. In this article we discuss methods to assess the anticoagulant effect of these agents, specific and general antidotes, and management of complications such as embolic and haemorrhagic stroke, and significant bleeding.
December 2017: Arrhythmia & Electrophysiology Review
https://www.readbyqxmd.com/read/29326127/skill-sets-required-for-the-management-of-military-head-face-and-neck-trauma-a-multidisciplinary-consensus-statement
#2
John Breeze, R Blanch, J Baden, A M Monaghan, D Evriviades, S E Harrisson, S Roberts, A Gibson, N MacKenzie, D Baxter, A J Gibbons, S Heppell, J G Combes, R F Rickard
INTRODUCTION: The evolution of medical practice is resulting in increasing subspecialisation, with head, face and neck (HFN) trauma in a civilian environment usually managed by a combination of surgical specialties working as a team. However, the full combination of HFN specialties commonly available in the NHS may not be available in future UK military-led operations, necessitating the identification of a group of skill sets that could be delivered by one or more deployed surgeons. METHOD: A systematic review was undertaken to identify those surgical procedures performed to treat acute military head, face, neck and eye trauma...
January 10, 2018: Journal of the Royal Army Medical Corps
https://www.readbyqxmd.com/read/29325196/ventral-slot-surgery-to-manage-cervical-intervertebral-disc-disease-in-three-cats
#3
Abbe Harper Crawford, Rodolfo Cappello, Akash Alexander, Steven De Decker
OBJECTIVE:  This case series describes the clinical presentation, management and outcome of three cats diagnosed with cervical intervertebral disc disease that underwent decompressive ventral slot surgery. METHODS:  This is a retrospective case series evaluating client-owned cats undergoing a ventral slot surgical procedure to manage cervical intervertebral disc disease (n = 3). RESULTS:  A routine ventral slot surgery was performed in each case without complication, resulting in postoperative neurological improvement in all three cases...
January 2018: Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T
https://www.readbyqxmd.com/read/29310618/epidemiology-of-unplanned-out-of-hospital-births-attended-by-paramedics
#4
Gayle McLelland, Lisa McKenna, Amee Morgans, Karen Smith
BACKGROUND: Over the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns. This research reports the clinical profile of a 1-year sample caseload of births attended by a state-wide ambulance service in Australia...
January 8, 2018: BMC Pregnancy and Childbirth
https://www.readbyqxmd.com/read/29309952/application-of-tourniquet-in-civilian-trauma-systematic-review-of-the-literature
#5
Charlotte Beaucreux, Benoît Vivien, Ethan Miles, Sylvain Ausset, Pierre Pasquier
INTRODUCTION: The effectiveness of a tourniquet (TQ) in case of extremity haemorrhages is well recognised to prevent death on the battlefield. However, little is known about the usefulness of TQ in civilian trauma settings, including terrorist attack situations. The aim of this systematic review was to analyse the evidence-based medical literature in order to precise the use of TQ in the management of extremity haemorrhages in civilian setting. METHODS: Analysis of all studies published until 12/31/2016 on the Embase, Medline and Opengrey databases...
January 5, 2018: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/29306488/reintroduction-of-anticoagulant-therapy-after-intracranial-haemorrhage-if-and-when
#6
REVIEW
Martin Scott, Ryan Low, Dawn Swan, Jecko Thachil
Intracranial haemorrhage is a devastating complication of anticoagulation. In surviving patients, physicians will be faced with the dilemma of if and when treatment should be reintroduced. There is little evidence to support this decision making and guidelines refrain from making specific recommendations. Existing data relates almost exclusively to vitamin K antagonists and is entirely retrospective. There appears to be an overall benefit to reintroducing anticoagulation in most patients; although, this may not be advocated in those at the highest risk of recurrent bleeding...
December 20, 2017: Blood Reviews
https://www.readbyqxmd.com/read/29305372/uterocutaneous-fistula-following-b-lynch-suture-for-primary-postpartum-haemorrhage
#7
Monika Thakur, Sandeep S Rathore, Aditi Jindal, Kunal Mahajan
A 30-year-old woman, who had undergone emergency lower segment caesarean section (LSCS) for failed induction 2 months back, presented with a fistulous opening along with discharge from her previous incision scar. She had developed a massive primary postpartum haemorrhage at the time of LSCS 2 months back, which was managed with B-Lynch suture and vessel ligation. Fistulogram revealed a connection between the uterus and the skin. The diagnosis was confirmed by a contrast-enhanced CT scan. Patient was subjected to laparotomy...
January 5, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29304556/diagnosis-treatment-and-outcome-of-arterioureteral-fistula-the-urologist-s-perspective
#8
Hendrik Heers, Christopher Netsch, Konrad Wilhelm, Armin Secker, Florian Kurtz, Philipp Spachmann, Simon Viniol, Rainer Hofmann, Axel Hegele
Introduction Arterioureteral fistula (AUF) is a rare but potentially life-threatening disease which primarily arises as a long-term complication in oncological patients who have permanent ureteric stenting. The incidence is rising. The objective of this study was to outline the risk factors for, management and outcome of AUF in a large individual case series. Patients and methods 26 AUF cases in 24 patients from six German tertiary referral centres occurring between 2008 and 2016 were identified retrospectively and entered into a dedicated database using patient notes and out-patient visits...
January 5, 2018: Journal of Endourology
https://www.readbyqxmd.com/read/29303230/planned-birth-at-or-near-term-for-improving-health-outcomes-for-pregnant-women-with-gestational-diabetes-and-their-infants
#9
REVIEW
Linda M Biesty, Aoife M Egan, Fidelma Dunne, Eugene Dempsey, Pauline Meskell, Valerie Smith, G Meabh Ni Bhuinneain, Declan Devane
BACKGROUND: Gestational diabetes is a type of diabetes that occurs during pregnancy. Women with gestational diabetes are more likely to experience adverse health outcomes such as pre-eclampsia or polyhydramnios (excess amniotic fluid). Their babies are also more likely to have health complications such as macrosomia (birthweight > 4000 g) and being large-for-gestational age (birthweight above the 90th percentile for gestational age). Current clinical guidelines support elective birth, at or near term in women with gestational diabetes to minimise perinatal complications, especially those related to macrosomia...
January 5, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29301646/impact-of-sex-on-comparative-outcomes-of-radial-versus-femoral-access-in-patients-with-acute-coronary-syndromes-undergoing-invasive-management-data-from-the-randomized-matrix-access-trial
#10
Giuseppe Gargiulo, Sara Ariotti, Pascal Vranckx, Sergio Leonardi, Enrico Frigoli, Nestor Ciociano, Carlo Tumscitz, Francesco Tomassini, Paolo Calabrò, Stefano Garducci, Gabriele Crimi, Giuseppe Andò, Maurizio Ferrario, Ugo Limbruno, Bernardo Cortese, Paolo Sganzerla, Alessandro Lupi, Filippo Russo, Roberto Garbo, Arturo Ausiello, Dennis Zavalloni, Gennaro Sardella, Giovanni Esposito, Andrea Santarelli, Simone Tresoldi, Marco Stefano Nazzaro, Antonio Zingarelli, Anna Sonia Petronio, Stephan Windecker, Bruno R da Costa, Marco Valgimigli
OBJECTIVES: This study sought to assess whether transradial access (TRA) compared with transfemoral access (TFA) is associated with consistent outcomes in male and female patients with acute coronary syndrome undergoing invasive management. BACKGROUND: There are limited and contrasting data about sex disparities for the safety and efficacy of TRA versus TFA for coronary intervention. METHODS: In the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) program, 8,404 patients were randomized to TRA or TFA...
January 8, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29298715/the-potential-of-task-shifting-selected-maternal-interventions-to-auxiliary-midwives-in-myanmar-a-mixed-method-study
#11
Kyu Kyu Than, Khaing Nwe Tin, Thazin La, Kyaw Soe Thant, Theingi Myint, James G Beeson, Stanley Luchters, Alison Morgan
BACKGROUND: An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar...
January 3, 2018: BMC Public Health
https://www.readbyqxmd.com/read/29297368/the-bloody-mess-of-red-blood-cell-transfusion
#12
REVIEW
Susilo Chandra, Hrishikesh Kulkarni, Martin Westphal
Red blood cell (RBC) transfusion might be life-saving in settings with acute blood loss, especially uncontrolled haemorrhagic shock. However, there appears to be a catch-22 situation reflected by the facts that preoperative anaemia represents an independent risk factor for postoperative morbidity and mortality, and that RBC transfusion might also contribute to adverse clinical outcomes. This dilemma is further complicated by the difficulty to define the "best" transfusion trigger and strategy. Since one size does obviously not fit all, a personalised approach is merited...
December 28, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29297205/cyclophosphamide-for-connective-tissue-disease-associated-interstitial-lung-disease
#13
REVIEW
Hayley Barnes, Anne E Holland, Glen P Westall, Nicole Sl Goh, Ian N Glaspole
BACKGROUND: Approximately one-third of individuals with interstitial lung disease (ILD) have associated connective tissue disease (CTD). The connective tissue disorders most commonly associated with ILD include scleroderma/systemic sclerosis (SSc), rheumatoid arthritis, polymyositis/dermatomyositis, and Sjögren's syndrome. Although many people with CTD-ILD do not develop progressive lung disease, a significant proportion do progress, leading to reduced physical function, decreased quality of life, and death...
January 3, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29295777/hereditary-haemorrhagic-telangiectasia-in-pregnancy-regional-and-general-anaesthesia
#14
M Crawford, R Burns, S Cooper, T Mackay
Hereditary haemorrhagic telangiectasia, also known as Osler-Weber-Rendu disease, is a rare autosomal dominant multisystem disorder, characterised by mucocutaneous telangiectases and arteriovenous malformations affecting any organ. The physiological changes in pregnancy pose significant obstetric and anaesthetic challenges for women affected by the disease. The optimal timing and mode of delivery requires careful consideration; and the benefits and risks of both regional and general anaesthetic techniques must be carefully considered, depending on the organs affected...
November 13, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/29282142/promoting-recruitment-using-information-management-efficiently-prime-a-stepped-wedge-cluster-randomised-trial-of-a-complex-recruitment-intervention-embedded-within-the-restart-or-stop-antithrombotics-randomised-trial
#15
Amy E Maxwell, Richard A Parker, Jonathan Drever, Anthony Rudd, Martin S Dennis, Christopher J Weir, Rustam Al-Shahi Salman
BACKGROUND: Few interventions are proven to increase recruitment in clinical trials. Recruitment to RESTART, a randomised controlled trial of secondary prevention after stroke due to intracerebral haemorrhage, has been slower than expected. Therefore, we sought to investigate an intervention to boost recruitment to RESTART. METHODS/DESIGN: We conducted a stepped-wedge, cluster randomised trial of a complex intervention to increase recruitment, embedded within the RESTART trial...
December 28, 2017: Trials
https://www.readbyqxmd.com/read/29248587/enhanced-case-management-can-be-delivered-for-patients-with-evd-in-africa-experience-from-a-uk-military-ebola-treatment-centre-in-sierra-leone
#16
S J Dickson, K A Clay, M Adam, C Ardley, M S Bailey, D S Burns, A T Cox, D G Craig, M Espina, G Fitchett, J Grindrod, D E Hinsley, S Horne, E Hutley, A M Johnston, R L C Kao, L E Lamb, S Lewis, D Marion, A J Moore, T C Nicholson-Roberts, A Phillips, J Praught, P S Rees, I Schoonbaert, T Trinick, D R Wilson, A J Simpson, D Wang, M K O'Shea, T E Fletcher
BACKGROUND: Limited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with EVD (Ebola virus disease) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting. METHODS: Demographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015...
December 14, 2017: Journal of Infection
https://www.readbyqxmd.com/read/29248163/estimated-absolute-effects-on-efficacy-and-safety-outcomes-of-using-non-vitamin-k-antagonist-oral-anticoagulants-in-real-world-atrial-fibrillation-patients-a-comparison-with-optimally-acenocoumarol-anticoagulated-patients
#17
María Asunción Esteve-Pastor, José Miguel Rivera-Caravaca, Vanessa Roldán, Vicente Vicente, Giulio Francesco Romiti, Imma Romanazzi, Marco Proietti, Mariano Valdés, Francisco Marín, Gregory Y H Lip
BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have been proposed as an alternative to vitamin K antagonists (VKA) for atrial fibrillation (AF) patients. Some studies have proposed that well-managed warfarin therapy is still a valid alternative as efficacious as NOACs but the potential impact and absolute effect of NOACs in "real world" optimally management of VKA AF patients is unknown. PURPOSE: To estimate the potential absolute benefit in clinical outcome rates if the optimally anticoagulated "real-world" AF patients with acenocoumarol had been treated with NOACs...
December 14, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29246935/cocaine-induced-pseudo-wellens-syndrome-a-wellens-phenocopy
#18
Aung Naing Lin, Sithu Lin, Rahul Gokhroo, Deepika Misra
Wellens' syndrome represents critical occlusion of the proximal left anterior descending coronary artery. Electrocardiographic changes similar to Wellens' wave are not exceptional to acute coronary occlusion and can also be seen in cardiac and non-cardiac conditions, such as left ventricular hypertrophy, persistent juvenile T wave, bundle branch blocks, cerebral haemorrhage, pulmonary oedema, pulmonary embolism, pheochromocytoma, Takotsubo syndrome, digitalis and cocaine-induced coronary vasospasm. Cocaine-induced pseudo-Wellens' syndrome should be considered as one of the differentials, since cocaine is used frequently by young adults and can cause left anterior descending coronary vasospasm mimicking Wellens' syndrome...
December 14, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29241907/a-systematic-review-of-massive-transfusion-protocol-in-obstetrics
#19
REVIEW
Hiroaki Tanaka, Shigetaka Matsunaga, Tomoyuki Yamashita, Toshiyuki Okutomi, Atsushi Sakurai, Akihiko Sekizawa, Junichi Hasegawa, Katsuo Terui, Yasutaka Miyake, Jun Murotsuki, Tomoaki Ikeda
Post-partum obstetric haemorrhage is a leading cause of mortality among Japanese women, generally treated with haemostatic measures followed by supplementary transfusion. Commonly used in the setting of severe trauma, massive transfusion protocols (MTPs), preparations of red blood cell concentrate (RBC) and fresh frozen plasma (FFP) with additional supplements, have proved effective in decreasing patient mortality following major obstetric bleeding events. Although promising, the optimal configuration of RBC and FFP utilized for obstetric bleeding needs to be verified...
December 2017: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/29240068/-treatment-of-a-woman-with-phlegmasia-cerulea-dolens-complicated-by-massive-pulmonary-thromboembolism-and-intestinal-haemorrhage
#20
E Iu Belousov, V V Soroka, K N Fomin
Acute thrombosis of the lower limb deep veins remains one of the most common vascular diseases. It is characterised by formation of thrombotic masses in the system of the deep veins of the lower extremities. A serious complication associated with deep vein thrombosis is pulmonary embolism. In rare cases, under certain conditions a massive and disseminated blockade of the venous outflow with thrombotic masses may lead to ischaemia of the extremity with the formation of superficial and deep necroses and later on to gangrene...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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