Harefuah
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Comparative Study
[Asthma management in adult emergency departments in Israel in comparison to asthma guidelines].
Asthma management is in focus all over the world. It is constantly updated, including aspects of Emergency Department (ED) care, on the basis of global and national evidence-based clinical guidelines. Despite the existence of these guidelines, the management of asthma, including management in the ED, is lagging behind. ⋯ The discrepancies between the existing clinical guidelines for asthma management in the ED and its actual use on the one hand, and the agreement among EDs on the importance of the guidelines on the other hand, are raising the necessity for common guidelines for asthma management in the EDs in Israel. Perhaps, more importantly, it highlights the urgent need for new effective and creative ways to implement asthma guidelines into routine ED practice.
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Cardiovascular complications are important causes of morbidity with major non cardiac procedures. Preoperative risk stratification relies on the identification of the cardiac problem, its stability, its severity and previous treatment. The approach to risk stratifying preoperative patients should be performed by accepted guidelines used for patients with suspected coronary artery disease (CAD) or known CAD and not as an "obligatory test" prior to operation. ⋯ The use of invasive diagnostic and therapeutic methods, such as cardiac catheterization, PCI, CABG, has to be restricted only to patients who are at very high risk. The partial reduction of the cardiac event rate in the short term and monitoring for 24 hours after operation is most important, as well as the administration of beta blockers, starting prior to surgery. Furthermore, long term follow-up for cardiac events in these patients in essential, as the clinical predictors and cardiac tests performed for preoperative risk stratification are also used for long term prognosis.
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Various methods exist for rewarming hypothermia casualties. Most of these methods necessitate sophisticated medical equipment or vigorous hemodynamic and electrolytic monitoring. Therefore, only a few methods remain suitable for pre-hospital scenarios. ⋯ In moderate or severe hypothermia casualties, hypothermia (rectal temperature below 32 degrees C) however, is characterized by suppressed or deficient endogenous heat producing mechanisms. Passive rewarming is not enough in these cases, necessitating the addition of active, central or peripheral rewarming methods. Studies regarding the use of various active rewarming methods in severe hypothermia casualties revealed low rewarming efficacy for the low heat capacity methods, such as warm air inhalation, and a high rewarming efficacy for the high heat capacity methods, such as forced air methods.
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A 9 month old girl at the emergency room appeared with an acute onset of restlessness, drooling and suspected foreign body ingestion. An X-Ray revealed an open safety pin in the child's upper aero-digestive tract. ⋯ Open safety pins in the aero-digestive tract are difficult to manage and great care must be taken during removal to prevent further injury. Parents should be counseled regarding the presence of safety pins in the child's surroundings in order to prevent such hazards.