Harefuah
-
Central venous catheterization is extensively used in unstable patients who need hemodynamic monitoring and in patients who require prolonged treatment such as, chemotherapy, antibiotics therapy, parenteral nutrition, or temporary hemodialysis. Subclavian vein catheterization is the preferred approach for hemodialysis, especially as it does not restrict the patient. Most of the complications related to this procedure are insignificant, however, occasionally they may be life threatening and require surgical intervention. ⋯ A subclavian catheter was inserted, and the patient started hemodialysis. Three weeks later, during hemodialysis, she complained of right upper abdominal and right chest pain. Chest X-ray showed a moderate to large right pleural effusion, with pleurocentesis confirming the presence of hemothorax.
-
Pain in the neonatal period is frequently experienced by 6-10% of newly born infants, preterm and term, who require neonatal intensive care. Repetitive painful procedures without adequate analgesia provided by the medical staff may bear long-term or even life-long adverse consequences. The use of pharmacological and non-pharmacological modalities in the management of pain may change this undesirable situation. ⋯ In addition to pain management in the neonatal intensive care units, neonatal circumcision is the most frequent surgical procedure performed in males, and is frequently conducted without appropriate analgesia. The simple available methods of analgesia for neonatal circumcision are discussed and should be employed in order to avoid painful circumcision. Many pediatric medical associations in the developed world consider failure to provide proper routine analgesia for neonatal circumcision to be an unethical and sub-optimal medical practice.
-
Beer potomania is a rare syndrome which is manifested by severe hyponatremia and various mental changes related to binge beer drinking and poor dietary intake. This article is a case study describing an alcoholic that was admitted because of this syndrome. We also discuss the pathophysiology of hyponatremia in alcoholics and especially in the syndrome of beer potomania.
-
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.
-
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.