Harefuah
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Secured airway is a must in spontaneous or assisted ventilation. A variety of methods are in clinical use for establishing an airway, of which endotracheal intubation is the most common. Difficulties in establishing a secured airway may deteriorate to a serious, and even a life-threatening situation. ⋯ This article describes an alternative technique for tracheal intubation, useful in such cases. Retrograde tracheal intubation is carried out by percutaneous insertion of a needle into the trachea in the subglotic region, passing a guidewire through the needle cephaled until it exits the mouth or nose and threading an endotracheal tube over the guidewire into the trachea. This technique is relatively easy and safe, and should be considered in difficult airway management.
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Rotavirus is a major cause of infantile gastroenteritis worldwide and remains a common cause of hospitalizations in developed countries. The study aimed to assess the hospitalizations due to rotavirus gastroenteritis in Israel and their characteristics. ⋯ Rotavirus gastroenteritis is an important cause for hospitalizations and complications in children < 5 years in Israel, stressing the need for safe and efficacious vaccines to reduce the burden of the infection.
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Ketoacidosis is a serious complication of diabetes mellitus, especially type 1, and its secondary consequences account for a large proportion of diabetes-related hospitalizations and mortality in children with type 1 diabetes. Our understanding of the pathophysiology of ketoacidosis has increased considerably, together with methods and means of management. Nevertheless, its incidence has remained constant in most parts of the western world, as has the incidence of cerebral edema, the main cause of death due to ketoacidosis. ⋯ Although studies of the risk factors for the development of cerebral edema in this setting have yielded discrepant findings, there is a wide consensus regarding ketoacidosis treatment. The accepted protocol consists of slow rehydration with isoosmotic fluids, without bicarbonate solution except in rare cases, with continuous attention to glucose, sodium and potassium levels and the patient's neurological state. The aim of this survey is to present guidelines for the treatment of diabetic ketoacidosis (DKA) in children and to recommend preventive measures.
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Opioids are considered a cornerstone in the treatment of cancer and non-cancer pain. The World Health Organization considers a country's morphine consumption to be an important indicator of the quality of pain control. There is little or no use of opioids in nearly half of the countries in the world. ⋯ During the 5 year period evaluated, there is a growing trend in use of opioids at CHS in Israel. This trend may be an indication of the improvement in treatment of chronic pain.
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We report the clinical and radiographic findings of a female patient who presented to the emergency room in acute distress due to a subluxated globe. The patient had a 10 year history of poorly controlled Grave's disease and associated orbitopathy. ⋯ To the best of our knowledge, this case is the first documented report of this unusual event occurring in a patient with significant involvement of the extraocular muscles which caused a resultant crowding of the orbital apex, disturbance to venous outflow and severe orbital congestion. In conclusion, acute globe subluxation may rarely happen in "myogenic" (type II) thyroid orbitopathy.