Curēus
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Introduction Close outpatient follow-up with a specialist or family physician post-discharge from the emergency department (ED) has been shown to increase adherence to antihypertensive medications, decrease mortality in heart failure, and reduce the odds of myocardial infarction or death after ED presentation for chest pain. A Canadian study demonstrated that 21% of patients who left the ED with a new diagnosis of atrial fibrillation, heart failure, or hypertension were not seen by a physician within 30 days. There is a paucity of research investigating why this follow-up does not occur. ⋯ ED physicians may consider giving explicit instructions to patients to improve monitoring of ongoing clinical issues. More research needs to be conducted on how to improve transitions of care. Countries with different healthcare models may have other barriers to appropriate follow-up.
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The combination of bradycardia, renal failure, atrioventricular (AV)-nodal blocker medications, shock, and hyperkalemia (BRASH) is a new syndrome that is a consequence of a positive loop of bradycardia due to AV-nodal blockers and hyperkalemia secondary to renal insufficiency. We present a case of BRASH syndrome in which the patient on chronic AV-nodal blockers presented with bradycardia, hypotension, underlying kidney dysfunction, and hyperkalemia. The patient was medically managed and discharged upon clinical improvement. The purpose of this report is to highlight the rare cases of BRASH syndrome and improve its management.
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Septorhinoplasty is a surgical procedure that provides functional improvements and esthetic adjustments to the appearance of the nose. Pain is a common postoperative complication, and pain management is known to decrease postoperative complications and total cost. Local anesthetics can cost-effectively decrease postoperative pain scores and reduce analgesic requirements. ⋯ The results showed that using bilateral infraorbital and infratrochlear nerve block injection with 0.25% levobupivacaine for patients who underwent septorhinoplasty under general anesthesia provided greater stability of vital signs but had no effect on the pain score or analgesia need. Further assessment should be performed in a larger number of patients to either confirm or refute these results. Additional studies could be conducted in several hospitals within the Kingdom to determine how broadly applicable nerve blockade is in reducing pain sensation.
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Background Acute pancreatitis (AP) is an inflammatory condition of the pancreas mostly due to alcohol or gallstones. Various scoring systems were involved in identifying the severity of the disease. The standard single score to identifying the severity remains uncertain. ⋯ Conclusion Among the scoring system compared, MGS had the highest sensitivity for predicting the severity of AP. However, Ranson score on admission had better diagnostic accuracy for predicting severity, organ failure, and mortality based on ROC curves. Procalcitonin had the best sensitivity, specificity, PPV, NPV, and diagnostic accuracy for association with severity in AP.
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Introduction Effective debriefing during simulation-based training (SBT) is critical to promote learning outcomes. Despite debriefing's central role in learning and various published debriefing methods and techniques, little is known about faculty development structure for debriefing training among novice facilitators. Continuing medical education courses often use simulation-based methods but provide minimal training in debriefing techniques to novice facilitators. ⋯ Facilitators' self- assessment in debriefing significantly improved on the 5-point Likert scale pre- and post-workshop, respectively. PC student learners' evaluations revealed high degrees of satisfaction with debriefing quality. Conclusions A proposed model integrating full-length debriefing and repetitive practice paired with summative and formative feedback provides a feasible and effective approach for debriefing training of novice facilitators for simulation-based educational courses.