Current opinion in critical care
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Curr Opin Crit Care · Aug 2011
ReviewRisk to and resilience of the coronary heart disease patient during surgery.
Three topics are at the forefront of the investigation and treatment of patients with coronary artery disease (CAD) undergoing major noncardiac surgery: prophylactic perioperative beta-blockade (PPBB), prophylactic statins and prophylactic preoperative coronary revascularization (PCR). The purpose of the review is to summarize the investigational efforts in each one of these fields and to provide a subjective evaluation as to their impact on perioperative patient care. ⋯ These topics demonstrate how difficult it is to prove a significant change in outcome in high-risk CAD patients by prophylactic preoperative measures and that there is no alternative to clinical judgment and individualized patient care.
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Curr Opin Crit Care · Aug 2011
ReviewIndications for single-dose activated charcoal administration in acute overdose.
Gastrointestinal decontamination in overdose patients remains a controversial problem in emergency medicine. There has been a significant decrease in the use of single-dose activated charcoal (SDAC) in recent years based on little new evidence and possibly because the overall mortality in overdose patients is low. ⋯ Although SDAC is unlikely to be beneficial in many overdose patients, for some subgroups with severe poisoning, the benefits will outweigh the low risk of administration. The use of SDAC should be based on the potential toxicity of the drug ingested and the potential benefit of SDAC balanced against the willingness of the patient to take SDAC and the low risk of administration.
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Curr Opin Crit Care · Aug 2011
ReviewManagement of severe acute asthma in the emergency department.
Asthma is one of the most common chronic diseases in most developed countries and control may be elusive. Deterioration in asthma control is common when patients are exposed to airway irritants, viruses, and/or when adherence to chronic anti-inflammatory medications is suboptimal. Acute asthma exacerbations are common, important reasons for presentations to emergency departments, and severe cases may result in hospitalization. Important knowledge gaps exist in what is known and what care is delivered at the bedside. ⋯ Treatment of severe acute asthma can effectively and safely reduce hospitalizations, airway interventions, and even death. Using the approach outlined herein will enable clinicians to assist patients to rapidly regain asthma control, return to normal activities, and improve their quality of life in the follow-up period.
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To examine recent developments in preventing and treating postoperative acute renal dysfunction. To review contemporary issues concerning perioperative fluid and electrolyte management. ⋯ Renal dysfunction, along with fluid and electrolyte disturbances, is a major issue that needs to be considered as part of perioperative management. Moreover, it is the prevention of clinically significant renal injury and electrolyte disturbances that is the cornerstone of contemporary anesthetic and surgical care.
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This article will review the incidence and most common causes of sudden cardiac death (SCD) in healthy young adults, including competitive athletes, as well as members of the general population. ⋯ Whether SCD is more common in athletes is the cause of continued debate stemming from conflicting data. Hypertrophic cardiomyopathy is the most common underlying cause of SCD in young athletes in most series; however, in nonathletic populations, the underlying causes of SCD are more varied.