Canadian journal of surgery. Journal canadien de chirurgie
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Malignant hyperthermia is a potentially fatal genetic myopathy that presents when the patient is under anesthesia. It manifests as a hypermetabolic state involving tachycardia, hypercarbia, base deficit, rigidity and fever. ⋯ Historically, there has been a reluctance in local community hospitals to manage patients known to be susceptible to malignant hyperthemia, and this is a source of frustration for many families in which there is a history of this condition. This article outlines the diagnosis and management of an acute malignant hyperthermic crisis from the viewpoint of a community general surgeon and provides a review of the management of patients known to be susceptible to this condition in the surgeon's elective and emergent practice.
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To review practice patterns in a Canadian pediatric centre and develop a safe and effective care plan for managing children with splenic injuries. ⋯ Reduced admissions to the intensive care unit, shorter overall stays, omission of follow-up imaging and an earlier return to full activity should be considered in the management of children with blunt splenic injuries. Standardization of nonoperative care for such children would result in safe and more efficient delivery of health care.
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To characterize medical and nonmedical reasons for delayed discharge on a general thoracic surgery unit. ⋯ Length of hospitalization after elective thoracic surgery may be prolonged for medical or nonmedical reasons. Although complications like persistent air leak and pneumonia have an impact on medically required length of stay, social factors may also significantly delay discharge.
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To demonstrate a clinical decision-making process by which to determine if heparin prophylaxis for deep venous thrombosis (DVT) is appropriate in a specific patient with multiple injuries. ⋯ Few of the multiple available studies concerning trauma, DVT and pulmonary embolism meet reasonable standards to establish clinical validity. Available guidelines for literature evaluation allow surgeons to select relevant articles for consideration. Patients with multiple trauma appear to be at significant risk for DVT. The death rate associated with subsequent pulmonary embolism is significant. There is reasonably good evidence to suggest that low molecular weight heparin will reduce this likelihood without a significant risk of treatment complications.