Ugeskrift for laeger
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The challenge of managing acute pain in opioid-addicted patients is a question of fully understanding the pharmacological effects of the illegal drugs and to prevent overdosing or withdrawal symptoms. It requires a thorough knowledge of the patient's daily consumption of legal and illegal drugs and an understanding obtained through an accepting and empathetic communication with the patient. Substitution management aims to prevent opioid withdrawal symptoms and is not a means of managing pain. When planning the pain management the patient must receive at least 25% of the daily methadone dose, recalculated into equipotent substitute morphine.
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Ugeskrift for laeger · May 2017
Review[High-isolation preparedness for very contagious and potential severely ill patients].
Ten and seven years ago respectively, the two high-isolation units in Denmark became prepared to receive highly contagious and potential severely ill patients. The units are located in the departments of infectious diseases in Hvidovre Hospital and Aarhus University Hospital. ⋯ Besides, a few possible candidates for Middle East respiratory syndrome patients were examined. Always being prepared in a busy clinical everyday environment is a challenge, and it takes regular training and exercises involving all personnel.
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Ugeskrift for laeger · Jan 2017
Review[Practical management of troponin screening after non-cardiac surgery].
Myocardial injury after non-cardiac surgery (MINS) is associated with significant morbidity and mortality. Routine troponin screening is necessary to identify patients with MINS. Although some evidence indicates benefit with aspirin and statin therapy in these patients, a number of clinical considerations must be done in the practical management of MINS. This article describes current experience with identification and treatment in Denmark of patients with MINS.
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Trauma haemorrhage is a common reversible cause of death. Haemostatic resuscitation focuses on replacing the lost blood with transfusions equivalent to whole blood as early as possible. In Denmark, the optimal ratio for transfusions in massive bleeding is four packs of red blood cells, four packs of plasma and one pool of platelets (equal to ratio 1:1:1 in USA). Haemostatic resuscitation also includes a restricted use of crystalloids, early tranexamic acid, and a goal-directed transfusion therapy by using viscoelastic haemostatic assays to detect coagulopathy and the need for additional transfusions or pro-haemostatics.
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In this article we discuss the current level of evidence for using a high inspiratory oxygen fraction (0.60-0.90) during surgery. More than 7,000 patients have been included in randomized trials, but no significant beneficial effect was found in a recent meta-analysis as compared with 0.30-0.40 oxygen. A high oxygen fraction should be used to correct or prevent hypoxaemia in special situations, but the available studies do not allow a recommendation to use a high inspiratory oxygen fraction as a routine practice in surgical patients.