Articles: patients.
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Succinylcholine is often used to facilitate neonatal and pediatric rapid sequence intubation in the emergency department, and most relevant literature recommends administering atropine prior to succinylcholine to reduce the risk of bradycardia. Given the potential complications associated with combining these medications, we searched the published literature for evidence supporting this practice. Most studies recommending atropine premedication were undertaken in the operating room setting and pertained to repeated succinylcholine dosing. ⋯ Several authors have called for the practice to cease, but, to date, these calls have gone unheeded. We found no evidence supporting atropine's use in pediatric patients prior to single-dose succinylcholine. Atropine premedication for emergency department rapid sequence intubation is unnecessary and should not be viewed as a "standard of care."
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Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments. ⋯ There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.
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Members of the CAS and subscribers to the CJA are first invited to read the introduction that follows and the articles cited in the bibliography to prepare for the Self-Assessment Program. The reader should then go to the Journal's website (www.cja-jca.org) for the Problem Based Learning session. Completion of the Self-Assessment Program will entitle subscribers to claim ten hours of Continuing Professional Development (CPD) under section 3 of CPD options, for a total of 20 Maintenance of Certification credits (note that section 3 hours are not limited to a maximum number of credits per five-year period). There is no requirement to succeed: the goal of participating is to define potential areas for improvement.
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Raised intracranial pressure is a relatively common problem facing the clinician treating neurocritically ill patients. It is a leading cause of death in patients with intracranial pathology. There is a lack of controlled clinical trials evaluating most of the therapies currently available for raised intracranial pressure. ⋯ Patients with raised intracranial pressure should be evaluated immediately with particular attention to airway and hemodynamic status. Controlled hyperventilation and hyperosmolality (using mannitol or hypertonic saline solutions) frequently are administered simultaneously. In patients with refractory elevation of intracranial pressure other therapies such as barbiturate coma and surgical interventions are available.
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Revista médica de Chile · Feb 2005
[Critical appraisal: enteral nutrition is better than parenteral nutrition for patients with acute pancreatitis].
To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. ⋯ Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.