Articles: cations.
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Critical care medicine · Aug 2023
Observational StudyPredicting the Development of Renal Replacement Therapy Indications by Combining the Furosemide Stress Test and Chemokine (C-C Motif) Ligand 14 in a Cohort of Postsurgical Patients.
Optimal timing of renal replacement therapy (RRT) initiation in severe acute kidney injury (AKI) remains controversial. Initiation of treatment early in the course of AKI may lead to some patients undergoing unnecessary RRT, whereas delayed treatment is associated with increased mortality. This study aims to investigate whether the combination of the furosemide stress test (FST) and AKI-associated biomarkers can predict the development of indications for RRT. ⋯ The combination of the FST with the renal biomarker CCL14 predicts the development of indications for RRT.
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Curr Opin Anaesthesiol · Aug 2023
ReviewRegional anesthesia in the emergency department outside the operating theatre.
Moderate to severe pain is common and remains a significant problem in the emergency department and regional anesthesia provides optimal and safe pain relief. This review aims to discuss the benefits, indications of the most common ultrasound-guided regional anesthesia techniques that can be provided by clinicians in the emergency department as part of multimodal analgesia. We will also comment on the education and training for effective and safe ultrasound-guided regional anesthesia in the emergency department. ⋯ Emergency physicians are perfectly placed to utilize the advantages of ultrasound-guided regional anesthesia. Various techniques can now be employed to cover most of the painful injuries presenting to the emergency department, thus modifying the morbidity and outcomes of emergency patients. Some of the new techniques require minimal training, provide safe and effective pain relief with low risk of complications. Ultrasound-guided regional anesthetic techniques should form an integral part of the curriculum of emergency department physicians.
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In the past 20 years of the Global War on Terror, the US has seen substantial improvements in its system of medical delivery in combat. However, throughout that conflict, enemy forces did not have parity with the weaponry, capability, or personnel of the US and allied forces. War against countries like China and Russia, who are considered near-peer adversaries in terms of capabilities, will challenge battlefield medical care in many different ways. ⋯ The team has extensive experience in medicine, surgery, austere environments, conflict zones, and building partner nation capacities. This article compares and contrasts the healthcare systems of this war against the systems used during the Global War on Terror. The lessons learned here could help the US anticipate challenges and successfully plan for the provision of medical care in a future conflict against an adversary with capabilities close to its own.
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Patients with frailty consistently experience higher rates of perioperative morbidity and mortality; however, costs attributable to frailty remain poorly defined. This study sought to identify older patients with and without frailty using a validated, multidimensional frailty index and estimated the attributable costs in the year after major, elective noncardiac surgery. ⋯ For patients with preoperative frailty having elective surgery, the authors estimate that attributable costs are increased 1.5-fold in the year after major, elective noncardiac surgery. These data inform resource allocation for patients with frailty.
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To better understand the established associations between hypocalcaemia and clinical outcomes, we synopsize the mechanisms involved in hypocalcaemia in the critically ill. We also provide an overview of the current evidence on managing hypocalcaemia in critical illness. ⋯ Hypocalcaemia is common in critically ill patients. Direct evidence that calcium supplementation improves their outcomes is lacking, and there is even some indication that it may be detrimental. Prospective studies are required to elucidate the risks and benefits, and the pathophysiological mechanisms involved.