Chest
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A 24-year-old previously healthy woman was brought to the hospital for acute altered mental status. One week prior to presentation, she had developed a sore throat, nausea, and vomiting. At that time, SARS-CoV-2 polymerase chain reaction and rapid streptococcal pharyngitis test results were both negative. ⋯ She was a student and worked part time in retail. She had no recent travel or outdoor exposure. The patient's family was unaware of any tobacco or drug use but did report that she drank socially.
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Randomized Controlled Trial Multicenter Study
Effect of Early High-Dose Vitamin D3 Repletion on Cognitive Outcomes in Critically Ill Adults.
Long-term cognitive impairment frequently occurs after critical illness; no treatments are known to improve long-term cognition. ⋯ In vitamin D-deficient, critically-ill adults, a large dose of enteral vitamin D3 did not improve long-term global cognition or executive function.
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Having a strategic plan is important to reach organizational goals. Equally important is knowing how to develop and execute that plan. Also, such plans evolve and are executed in the context of the organization's culture, which is another critical success element. ⋯ If the soil is fouled, no plants will grow, regardless of how appealing the garden plan. This "How We Do It" paper addresses the issue of developing and executing a strategy and then, in a companion piece, the related process of envisioning and cultivating an organizational culture. The strategic planning discussion invokes a "real-win-worth" paradigm to address the real-world case of assuring uniform, best-in-class ICU outcomes across multiple ICUs in a large academic medical center system.
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Traumatic brain injury (TBI) is a major global health problem and a major contributor to morbidity and mortality following multisystem trauma. Extracranial organ dysfunction is common after severe TBI and significantly impacts clinical care and outcomes following injury. Despite this, extracranial organ dysfunction remains an understudied topic compared with organ dysfunction in other critical care paradigms. In this review, we will: 1) summarize the epidemiology of extracranial multiorgan dysfunction following severe TBI; 2) examine relevant mechanisms that may be involved in the development of multi-organ dysfunction following severe TBI; and 3) discuss clinical management strategies to care for these complex patients.