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https://www.readbyqxmd.com/read/29906381/points-pearls-management-of-multiply-injured-pediatric-trauma-patients-in-the-emergency-department
#1
Andria Tatem, Rupa Kapoor, Bryan Wilson
Management of the child with multiple traumatic injuries can be challenging, and important injuries may not be readily recognized. Early recognition of serious injuries, initiation of appropriate diagnostic studies, and rapid stabilization of injuries are key to decreasing morbidity and mortality in the multiply injured pediatric trauma patient. The differential diagnosis for these patients is wide, and treatment is targeted to the specific injuries. In this issue, a systematic approach to the multiply injured pediatric patient will be reviewed, with specific attention to commonly missed injuries and those injuries that may cause significant morbidity or mortality...
June 1, 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29887195/misconceptions-in-acute-heart-failure-diagnosis-and-management-in-the-emergency-department
#2
REVIEW
Brit Long, Alex Koyfman, Eric J Chin
INTRODUCTION: Acute heart failure (AHF) accounts for a significant number of emergency department (ED) visits, and the disease may present along a spectrum with a variety of syndromes. OBJECTIVE: This review evaluates several misconceptions concerning heart failure evaluation and management in the ED, followed by several pearls. DISCUSSION: AHF is a heterogeneous syndrome with a variety of presentations. Physicians often rely on natriuretic peptides, but the evidence behind their use is controversial, and these should not be used in isolation...
June 1, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29807480/life-sustaining-procedures-palliative-care-consultation-and-do-not-resuscitate-status-in-dying-patients-with-copd-in-us-hospitals-2010-2014
#3
Jay J Shen, Eunjeong Ko, Pearl Kim, Sun Jung Kim, Yong-Jae Lee, Jae-Hoon Lee, Ji Won Yoo
AIM: Little is known regarding the extent to which dying patients with chronic obstructive pulmonary disease (COPD) receive life-sustaining procedures and palliative care in US hospitals. We examined temporal trends and the impact of palliative care on the use of life-sustaining procedures in this population. MATERIALS AND METHODS: A retrospective nationwide cohort analysis was performed using weighted National Inpatient Sample (NIS) data obtained from 2010 to 2014...
January 1, 2018: Journal of Palliative Care
https://www.readbyqxmd.com/read/29803818/perinatal-anxiety-approach-to-diagnosis-management-in-the-obstetric-setting
#4
REVIEW
Katie R Thorsness, Corey Watson, Elizabeth M Larusso
Anxiety is common in women during the perinatal period, manifests with various symptomatology and severity, and is associated with significant maternal morbidity and adverse obstetrical and neonatal outcomes. Given the intimate relationship and frequency of contact, the obstetric provider is optimally positioned to create a therapeutic alliance and manage perinatal anxiety. Time constraints, absence of randomized controlled trials, mixed quality of data, and concern for potential adverse reproductive outcomes all limit clinicians' ability to initiate informed risk-benefit discussions...
May 24, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29794318/-dissecting-aneurysm-of-the-distal-middle-cerebral-artery-formed-the-out-pouch-during-long-term-follow-up-a-case-report
#5
Mitsuya Watanabe, Eiji Abe, Reo Ishimoto, Naohide Fujita, Hiroshi Hasegawa, Hideaki Ueno, Yasuaki Nakao, Takuji Yamamoto, Ryo Wada
A 40-year-old man with a rare case of dissecting aneurysm of the distal middle cerebral artery(MCA, M2 segment)presented with ischemic stroke, manifesting as headache, nausea, and visual disorder. Computed tomography(CT)scan revealed cerebral infarction, and three-dimensional CT angiogram revealed stenotic change at the M2 segment. The patient was conservatively treated and remained neurologically stable. Ten months later, CT scan and magnetic resonance imaging(MRI)revealed outpouching of the M2 segment at the location of the initial stenosis...
May 2018: No Shinkei Geka. Neurological Surgery
https://www.readbyqxmd.com/read/29718649/synthetic-drug-intoxication-in-children-recognition-and-management-in-the-emergency-department-digest
#6
Rahul Shah, Carl R Baum, Kathryn H Pade
When children and adolescents present to the emergency department with agitation or mental status changes, intoxication from synthetic drug use should be in the differential diagnosis. Identifying the responsible compound(s) may be difficult, so asking the patient broad questions and utilizing appropriate diagnostic studies, when indicated, will aid in making the diagnosis and help identify more-serious complications. This issue discusses the challenges presented by the changing chemical formulations of synthetic cannabinoids, cathinones, and phenethylamines; outlines common presentations of intoxication from these substances; and summarizes best practices for evaluating and managing patients who present with intoxication after consumption of these synthetic drugs of abuse...
May 1, 2018: Pediatric Emergency Medicine Practice
https://www.readbyqxmd.com/read/29717846/recognizing-and-managing-emerging-infectious-diseases-in-the-emergency-department-digest
#7
Ramón Millán, Deepti Thomas-Paulose, Daniel J Egan, Jeffrey Nusbaum, Nachi Gupta
With population shifts, increased travel, and climate change, the spread of emerging and re-emerging infections is increasing. Although encountering a patient with an emerging infection on any given emergency department shift is unlikely, missing a diagnosis could have profound consequences for the patient, healthcare workers, and the patient's close contacts. This review provides a framework to evaluate, diagnose, and treat a returning traveler with suspected Middle East respiratory syndrome, chikungunya virus, or Zika virus-3 recently emerged infections...
May 1, 2018: Emergency Medicine Practice
https://www.readbyqxmd.com/read/29686118/pearls-oy-sters-the-critical-role-of-histopathology-in-diagnosing-cancer-associated-necrotizing-cns-vasculitis
#8
Joshua Sheehan, Jessica Tate, Ryan Mott, Carol Geer, Rachel Wolfe, Roy E Strowd, Amy Guzik
OBJECTIVE: To highlight the importance of a broad differential and histopathologic confirmation in patients with newly diagnosed cancer with brain lesions atypical for CNS metastasis. METHODS: We report 2 cases of biopsy-proven CNS vasculitis in patients undergoing treatment for a newly diagnosed nonmetastatic cancer. Comprehensive medical record review was performed to identify the clinical presentation, representative neuroimaging, histopathologic features, and response to treatment...
April 24, 2018: Neurology
https://www.readbyqxmd.com/read/29674398/intestinal-granulomatous-disease-what-is-the-first-call
#9
Alex Guri, Michal Kori, Pearl Herskovitz, Oren Zimhony
A 15-year-old girl presented with erythema nodosum and mild abdominal complaints. Her intestinal granulomatous disease was erroneously diagnosed as Crohn's disease despite the fact that the possibility of tuberculosis was considered. The final diagnosis of tuberculosis was made only when an anti-tumour necrosis factor therapy resulted in further deterioration. The patient was treated with isoniazid, rifampin, pyrazinamide and ethambutol, with slow and steady clinical improvement until complete recovery was achieved...
April 19, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29669671/drug-induced-eosinophilia
#10
Christine Rauscher, Allison Freeman
BACKGROUND: Drug reactions have been associated with increased blood eosinophil levels. OBJECTIVE: To review clinical characteristics, the diagnosis, and the management of drug-induced eosinophilia. METHODS: Pertinent articles were selected and reviewed in relation to a case presentation of drug-induced eosinophilia. RESULTS: A case of asymptomatic eosinophilia in the setting of acetylsalicylic acid (aspirin) use was presented, followed by discussion of the clinical characteristics, diagnosis, and management of drug-induced eosinophilia...
May 1, 2018: Allergy and Asthma Proceedings:
https://www.readbyqxmd.com/read/29656858/a-recurrent-de-novo-pacs2-heterozygous-missense-variant-causes-neonatal-onset-developmental-epileptic-encephalopathy-facial-dysmorphism-and-cerebellar-dysgenesis
#11
Heather E Olson, Nolwenn Jean-Marçais, Edward Yang, Delphine Heron, Katrina Tatton-Brown, Paul A van der Zwaag, Emilia K Bijlsma, Bryan L Krock, E Backer, Erik-Jan Kamsteeg, Margje Sinnema, Margot R F Reijnders, David Bearden, Amber Begtrup, Aida Telegrafi, Roelineke J Lunsing, Lydie Burglen, Gaetan Lesca, Megan T Cho, Lacey A Smith, Beth R Sheidley, Christelle Moufawad El Achkar, Phillip L Pearl, Annapurna Poduri, Cara M Skraban, Jennifer Tarpinian, Addie I Nesbitt, Dietje E Fransen van de Putte, Claudia A L Ruivenkamp, Patrick Rump, Nicolas Chatron, Isabelle Sabatier, Julitta De Bellescize, Laurent Guibaud, David A Sweetser, Jessica L Waxler, Klaas J Wierenga, Jean Donadieu, Vinodh Narayanan, Keri M Ramsey, Caroline Nava, Jean-Baptiste Rivière, Antonio Vitobello, Frédéric Tran Mau-Them, Christophe Philippe, Ange-Line Bruel, Yannis Duffourd, Laurel Thomas, Stefan H Lelieveld, Janneke Schuurs-Hoeijmakers, Han G Brunner, Boris Keren, Julien Thevenon, Laurence Faivre, Gary Thomas, Christel Thauvin-Robinet
Developmental and epileptic encephalopathies (DEEs) represent a large clinical and genetic heterogeneous group of neurodevelopmental diseases. The identification of pathogenic genetic variants in DEEs remains crucial for deciphering this complex group and for accurately caring for affected individuals (clinical diagnosis, genetic counseling, impacting medical, precision therapy, clinical trials, etc.). Whole-exome sequencing and intensive data sharing identified a recurrent de novo PACS2 heterozygous missense variant in 14 unrelated individuals...
May 3, 2018: American Journal of Human Genetics
https://www.readbyqxmd.com/read/29644869/pearls-and-pitfalls-in-imaging-of-blunt-traumatic-thoracic-aortic-injury-a-pictorial-review
#12
Neeral R Patel, Elizabeth Dick, Nicola Batrick, Michael Jenkins, Elika Kashef
Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high-velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist. It is therefore of paramount importance that radiologists are familiar with both the direct (intimal flap, pseudoaneurysm, aortic contour irregularity and contrast extravasation) and indirect (periaortic haematoma) imaging findings of TAI...
April 16, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29629646/fibroblastic-osteosarcoma-with-epithelioid-and-squamous-differentiation-in-a-dog
#13
Tiffany L Jenkins, Dalen Agnew, Daniel R Rissi
A fibroblastic osteosarcoma with epithelioid and squamous differentiation in the distal femur of a 9-y-old spayed female Greyhound dog is described. Grossly, the tumor consisted of a pale-white, firm-to-hard mass that replaced the medullary and cortical areas of the distal end of the right femur. Histologically, the mass was composed predominantly of spindle cells admixed with areas of mineralized and non-mineralized osteoid matrix that were surrounded by stellate osteoblasts and scattered multinucleate giant cells, consistent with the diagnosis of a fibroblastic osteosarcoma...
April 1, 2018: Journal of Veterinary Diagnostic Investigation
https://www.readbyqxmd.com/read/29622328/inborn-errors-of-metabolism-in-the-emergency-department-undiagnosed-and-management-of-the-known
#14
REVIEW
Emily C MacNeill, Chantel P Walker
An inborn error of metabolism should be considered in any neonate who presents to the emergency department in extremis and in any young child who presents with altered mental status and vomiting. In children with unknown diagnoses, it is crucial to draw the appropriate laboratory studies before the institution of therapy, although treatment needs rapid institution to mitigate neurologic damage and avoid worsening metabolic crisis. Although there are hundreds of individual genetic disorders, they are roughly placed into groups that present similarly...
May 2018: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/29618113/surgical-resection-of-intramedullary-epidermoid-cyst-2-dimensional-operative-video
#15
Thomas Sorenson, Giuseppe Lanzino
Intramedullary epidermoid cysts are extremely rare lesions. Preoperative diagnosis can be challenging due to non-specific imaging futures. We illustrate the case of a 32-year-old man who presented with a symptomatic intramedullary mass, which at surgery proved to be an epidermoid cyst. The spinal cord was decompressed by removing the pearl-white keratin material, although the capsule, which was tenaciously adherent to the surrounding spinal cord parenchyma, was only partially removed. In this video, we illustrate the salient surgical points for the resection of this very unusual intramedullary lesion...
March 30, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29550866/fetal-anterior-abdominal-wall-defects-prenatal-imaging-by-magnetic-resonance-imaging
#16
REVIEW
Teresa Victoria, Savvas Andronikou, Diana Bowen, Pablo Laje, Dana A Weiss, Ann M Johnson, William H Peranteau, Douglas A Canning, N Scott Adzick
Abdominal wall defects range from the mild umbilical cord hernia to the highly complex limb-body wall syndrome. The most common defects are gastroschisis and omphalocele, and the rarer ones include the exstrophy complex, pentalogy of Cantrell and limb-body wall syndrome. Although all have a common feature of viscera herniation through a defect in the anterior body wall, their imaging features and, more important, postnatal management, differ widely. Correct diagnosis of each entity is imperative in order to achieve appropriate and accurate prenatal counseling and postnatal management...
April 2018: Pediatric Radiology
https://www.readbyqxmd.com/read/29537292/necrotizing-fasciitis-of-the-lower-extremity-imaging-pearls-and-pitfalls
#17
David K Tso, Ajay K Singh
OBJECTIVE: The purpose of this article is to review the imaging findings of necrotizing fasciitis as seen on radiograph, ultrasound, CT, and MRI, and to recognize the early findings in this potentially fatal disease. CONCLUSION: Although classically a clinical diagnosis, imaging is a powerful adjunct to facilitate early diagnosis in equivocal cases. Compared to plain radiography, ultrasound, CT and MR provide higher sensitivity and specificity for the diagnosis of necrotizing fasciitis...
March 28, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29525276/meigs-to-modern-times-the-evolution-of-debulking-surgery-in-advanced-ovarian-cancer
#18
John O Schorge, Amy J Bregar, John Durfee, Ross S Berkowitz
Joe V. Meigs was a visionary clinician and an early adopter of radical techniques in the surgical treatment of ovarian cancer. His 1934 textbook "Tumors of the Female Pelvic Organs", consolidated his approach to this "hopeless" disease, with pearls on diagnosis, outcomes, and even speculations about the benefits of minimally invasive surgery. Decades before adjuvant chemotherapy would prove of value, and in an era when sophisticated statistics were unheard of, he nonetheless tried to eke out what benefits he could using the methods available in his time...
March 7, 2018: Gynecologic Oncology
https://www.readbyqxmd.com/read/29507134/pearls-oy-sters-ocular-motor-apraxia-as-essential-differential-diagnosis-to-supranuclear-gaze-palsy-eyes-up
#19
Kerstin Schweyer, Marc Aurel Busche, Jochen Hammes, Andreas Zwergal, Carsten Buhmann, Thilo van Eimeren, Günter U Höglinger
No abstract text is available yet for this article.
March 6, 2018: Neurology
https://www.readbyqxmd.com/read/29489307/emergency-department-management-of-smoke-inhalation-injury-in-adults-digest
#20
Karalynn Otterness, Christine Ahn, Jeffrey Nusbaum, Nachi Gupta
Smoke inhalation injury portends increased morbidity and mortality in fire-exposed patients. Upper airway thermal burns, inflammation from lower airway irritants, and systemic effects of carbon monoxide and cyanide can contribute to injury. A standardized diagnostic protocol for inhalation injury is lacking, and management remains mostly supportive. Clinicians should maintain a high index of suspicion for concomitant traumatic injuries. Diagnosis is mostly clinical, aided by bronchoscopy and other supplementary tests...
March 1, 2018: Emergency Medicine Practice
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