JAMA : the journal of the American Medical Association
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"Do not resuscitate" (DNR) decisions were examined in a medical intensive care unit (MICU) of a 1,000-bed hospital. Seventy-one (14%) of 506 study patients were designated DNR; nine survived hospitalization. Severity of illness, age, and prior health were predictive of DNR orders; race and socioeconomic factors were not. ⋯ Documented justifications of DNR decisions included poor prognosis (59%), poor quality of life (24%), and patients' wishes (15%). There were no written justifications for the DNR decisions in 30 cases (42%). Although willingness to write DNR orders in an MICU and continued active treatment of DNR patients are both reassuring in a general sense, they raise questions about the consistency of treatment plans and goals for individual patients.
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Most facial injuries that occur during athletic activities are of a minor nature, consisting of lacerations, contusions, and abrasions. These are usually treated by a team physician or an emergency department physician. ⋯ Soft-tissue trauma as well as fractures are included in this review, and evaluation of the injured athlete is emphasized. A systematic approach is developed for diagnosing and treating common facial injuries in athletes.
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Fifteen of 165 infants and young children who underwent surgical correction of congenital cardiac defects using profound hypothermic and circulatory arrest experienced generalized or focal seizures postoperatively. The cause of the seizures was unexplained in ten. Among these ten, the onset of seizures was 25 to 48 hours after surgery. ⋯ Long-term anticonvulsant therapy was not required for any of the children. There was no correlation between the type of cardiac abnormality (cyanotic v acyanotic) or the duration of hypothermic circulatory arrest and the development of seizures. Unexplained seizures following cardiac surgery with hypothermia and circulatory arrest are not a sign of permanent brain damage and do not detract from the use of this technique for early definitive repair of congenital heart defects.
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The dipping of snuff provoked paroxysmal hypertension that induced myocardial ischemia in a 69-year-old woman with pheochromocytoma. The diagnosis of her tumor was delayed by a report of a falsely low urine metanephrine level, resulting from interference with the metanephrine assay by meglumine present in the urine because of contrast coronary angiography performed on the day of urine collection.