Brit J Hosp Med
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Vasopressor medications for circulatory shock have historically been administered through central venous catheters due to concern for extravasation injury when given peripherally. However, recent studies have demonstrated the safety of peripheral administration of vasopressor medications at lower doses and for a limited duration. Peripheral use of vasopressors is appealing to both patients and providers, as obtaining central access is an invasive procedure associated with the risk of pneumothorax, bleeding, and infection. ⋯ We discuss the guidelines and data for optimal dose, duration, intravenous line (IV) size, IV location, and nursing IV site monitoring for peripheral vasopressors. We then explore adverse events associated with peripheral vasopressors. Finally, we describe how this practice change may impact hospital medicine providers.
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Review
The influence of open-skill and closed-skill sports on executive functions: a systematic review.
Aims/Background Open-skill sports are reportedly more effective than closed-skill sports in improving executive functions. However, it remains unclear as to its superiority in specific components of executive functions and specific populations. This review aims to explore the degree to which specific components of executive functions are affected by different sport types, open-skill sports and closed-skill sports, among different age groups. ⋯ Six studies found that open-skill sports are conducive to inhibitory control and cognitive flexibility among children and adolescents, while four studies showed that open-skill sports greatly enhance inhibitory control in elderly individuals. Conclusion Compared with closed-skill sports, open-skill sports have a favourable impact on inhibitory control and cognitive flexibility in children, adolescents, and adults, marked by shorter response time in inhibitory control tasks, as well as shorter response time and lower switch costs in cognitive flexibility tasks. In addition, relative to closed-skill sports, open-skill sports heightens accuracy in working memory tasks among adults.
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Fractures of the tibial tubercle are an uncommon injury, constituting 0.4-2.7% of all epiphyseal injuries. They occur in the adolescent age group, often during sports such as basketball and football. ⋯ Tibial tubercle fractures generally have favourable overall outcomes when the correct treatment modality is chosen, with a high rate of union and a 98% return to preinjury activities. This article provides a guide for doctors on the classification and management of these injuries, to ensure that appropriate treatment is given according to current literature and best practice.
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Review
Don't forget the children-paediatric patients in mass casualty events and major incident planning.
Major incidents and mass casualty events can affect people of all ages. However, when planning the response to a major incident the focus is often on adult casualties rather than children. ⋯ The new Major Incident Triage Tool introduced in the National Health Service (NHS) in 2024 has a tendency to over triage paediatric casualties and so hospitals who may be receiving children following a UK major incident must be aware of this and plan for the potential implications. This article reviews the evidence and learning from previous mass casualty events and makes recommendations for hospitals to ensure that the needs of children will be met if a major incident occurs.
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Aims/Background Indeterminate cell histiocytosis is a rare proliferative histiocytic disease with an unknown aetiology, which shares immunophenotypic features of both Langerhans cells and macrophages. There is a relationship between indeterminate cell histiocytosis and cancer, while there are no reports about indeterminate cell histiocytosis and bullous pemphigoid. In this study, we reported the rare case of a patient with primary cutaneous indeterminate cell histiocytosis who had been diagnosed with oesophagal cancer and later developed bullous pemphigoid. ⋯ Histopathological examination of blisters and bullae on the lower limbs revealed a subepidermal blister with infiltration of a large number of eosinophils within the blister and the dermis beneath it. Direct immunofluorescence showed that immunoglobulin Gs (IgGs) were linearly deposited in the basal membrane zone. Conclusion The coexistence of oesophageal carcinoma, indeterminate cell histiocytosis, and bullous pemphigoid in a single patient represents a rare case that warrants consideration of possible underlying mechanisms.