Hospital practice (1995)
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Hospital practice (1995) · Dec 2009
Patients presenting with severe hypotonic hyponatremia: etiological factors, assessment, and outcomes.
Although hospital-acquired hyponatremia is well described, severe community-acquired hyponatremia has been studied less extensively. ⋯ Patients treated with thiazide or indapamide (particularly elderly women) may benefit from monitoring of serum sodium levels. Inappropriately rapid serum sodium correction is associated with osmotic demyelination, particularly in patients with risk factors for this condition. In contrast to what has been reported for hyponatremia in hospitalized patients, severity of hyponatremia on admission did not predict increased mortality in our patient population.
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Over 2.5 million accidental and intentional drug-related poisonings are reported annually in the United States. Early diagnosis and management of patients who present with acute intoxication can significantly reduce both morbidity and mortality. The initial evaluation of patients with suspected or proven intoxications should focus on hemodynamic stability, mental status, and respiratory function. ⋯ Important historical clues are often found in a social history that considers intravenous drug use, alcohol use, and any access or exposure to illicit substances. A patient's medication list should also be scrutinized for psychoactive or sedative medications, such as tricyclic antidepressants or opioids. In this article we present case-based discussions of the specific diagnosis and management of 5 commonly occurring acute intoxication syndromes.
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Hospital practice (1995) · Dec 2009
Application of a prediction rule to discriminate between aseptic and bacterial meningitis in adults.
Differentiating between aseptic and bacterial meningitis presents a difficult diagnostic challenge. Accurately ruling out bacterial meningitis may reduce unnecessary hospitalization, patient morbidity, and utilization of resources. This study applies a prediction rule previously developed in the pediatric population to an adult cohort. ⋯ The prediction rule, previously validated in a pediatric population, was accurate in ruling out bacterial meningitis in an adult cohort. Prospective validation in an adult population is warranted.
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Hospital practice (1995) · Dec 2009
Practical implementation of therapeutic hypothermia after cardiac arrest.
Survival after out-of-hospital cardiac arrest (OHCA) remains unacceptably low. Therapeutic hypothermia (TH) is the most efficacious treatment option available for comatose survivors of cardiac arrest. However, clearly delineated instructions for how to induce, maintain, and conclude TH have not been published in a codified format. ⋯ We present a step-by-step management plan for incorporation of TH in the care of the comatose survivor of OHCA, which can be adapted to a variety of clinical settings with diverse resources. This article is intended to supplement current care provided by health care providers and should be adopted in concert with current standards of post-arrest and intensive care unit care.