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By: O. Silvio, M.A.S., M.D.

Program Director, Des Moines University College of Osteopathic Medicine

The proliferation and explosion of electronic media has profound influence on people anxiety coping skills order phenergan uk. The enormous changes in medicine have led to previously unimaginable competition between hospitals and physicians and corporate hospitals clamoring for public attention of any type-advertising anxiety symptoms while falling asleep trusted 25 mg phenergan, news reports anxiety natural supplements phenergan 25mg discount, features, and stories. Electronic media has undergone an equally cataclysmic change as the number of channels and networks available to the public have exploded; intensifying the competitive pressure to find and report medical news before another network or program. Given this cauldron of competition, it is not surprising that some problematic and even dangerous practices have developed. Medical health news is covered extensively in exciting manner, but they should be exact. The fact is that we automatically expect our source on the medical side of medicine-media equation to have some kind of credentials, medical degree or an institutional affiliation, but we do not expect that of the media side even though both sides are critical to good reporting. It is high time in the era of highly specialized medical and scientific information to provide evidence of that the people on both sides know what they are doing. In contrast to general news, which is based on facts and sources and opinions, medical information is traditionally based on data, probabilities and conclusion. Good medical news reporting requires additional and very specific skills in the understanding of biostatistics and epidemiology. The need for such knowledge leads directly to the question of whether those who report medical news should have any specific training or credentials. Unfortunately, hardly any print or electronic media in our country has specialist medical journalists. They should develop some kind of system to ensure that those who wish to become medical journalists have a basic knowledge of the subject and some training that would be recognized by employers. News and reports concerning medicine and healthcare can have a far-reaching impact on the lives and wellbeing of people. As opposed to general news, medical news reporting requires niche skills and expertise in understanding biostatistics and epidemiology. In his book titled Beyond the Lines veteran journalist Kuldeep Nayar states the proliferation of newspapers and television channels no doubt affected the quality of content, particularly reporting. He adds that a shallow, unthinking attitude on the part of newspapers gets reflected in the news stories and articles they publish. Reporters do not always cross-check the information they receive and often write one-sided versions of events and about people of no consequence. With the field of medicine of such grave concern and importance to human life, accurate and insightful reporting is the need of the hour. If we want healthier, and happier lives, it is important for media and medicine to be in sync with each other. While the media industry has been facing the ire of the public, its role and importance in disseminating information to the masses is indisputable. Mark Twain once said, `Be careful about reading health books; you may die of a misprint or of a mistake. The fundamental question in medical journalism is how best to identify the process and report legitimate medical information to the general public. One commonly accepted definition of news is `anything that interests a large part of the community and has never been brought to its attention before. There is a tension between these two aims, because ultimately `the criterion of interest is that of the reader - the consumer of the newspaper - not the criterion of the scientist. The human interest approach itself generates a powerful incentive to ensure that the stories printed in the newspapers are accurate and reliable. If a story promises a cure for a certain disease, readers who have an affected relative and who are desperate for any hope will communicate directly with the journalist. Having to talk one to one with someone who has a painful personal interest in a story can be a salutary experience. Men of medicine and journalists are committed to communicate truth and the tensions over health or medical reporting have to do more with accuracy than with style. They influence the perception of public who are increasingly sensitive to the social and ethical implications of medicine. Media exposes of leaky silicone breast implants led to demands for remedial surgery. News reports about genetic mutations with predisposition to breast cancer brought women to clinics demanding genetic treatment or testing and preventive mastectomies.

Based on the severity of the clinical situation and in view of the relatively short half-life of the direct factor Xa inhibitors (5-15 hours) anxiety symptoms rapid heart rate buy 25 mg phenergan with visa, cessation of medication may often be sufficient to reverse the effect of anticoagulant in case of bleeding anxiety symptoms stomach cheap 25 mg phenergan with mastercard. Some authors argue that in most cases anxiety zoning out cheap phenergan 25 mg otc, this will suffice and more immediate reversal is hardly ever needed in clinical practice. However, additional non-specific as well as specific intervention may be required, if immediate reversal of anticoagulation is deemed necessary, as shown in Table 1. Ciraparantag does not bind to any of the human coagulation factors or serum albumin so has no procoagulant effect. Idarucizumab: Idarucizumab is a humanized mouse monoclonal antibody fragment targeted against dabigatran. It Patients with a severe coagulation factor deficiency or severe thrombocytopenia should receive appropriate factor replacement therapy or platelets, respectively. Activated charcoal may be used if the most recent dose of dabigatran, apixaban or rivaroxaban was taken < 2 hours earlier. Prevention of complications due to immobility through positioning, airway maintenance and mobilization within physiological tolerance. The consensus document from the brain attack coalition on comprehensive stroke centers delineates these as specific areas of monitoring and complication prevention in which nurses should be trained. A randomized trial, showing improved outcomes with tight glucose control using insulin infusions, has increased the use of this therapy. More recent studies have, however, demonstrated an increased incidence of systemic and cerebral hypoglycemic events and possibly even an increased risk of mortality in patients treated with this regimen. A cluster randomized trial of a set of interventions (managing fever, glucose and swallowing dysfunction in stroke units) found improved outcomes in a mixed cohort of ischemic and hemorrhagic stroke patients. Both hyperglycemia and hyglycemia should be avoided (Class I, Level of evidence C) (Revised from previous guideline). In patients surviving the first 72 hours after hospital admission, the duration of fever is related to outcome and appears to be an independent prognostic factor in these patients. Preliminary animal and human studies have suggested that therapeutic cooling may reduce perihematomal edema. Clinical seizures or electrographic seizures in patients with a change in mental status should be treated with antiseizure drugs. Risk factors for epilepsy include stroke severity, cortical location and delayed initial seizures. A formal screening procedure for dysphagia should be performed in all patients before the initiation of oral intake to reduce the risk of pneumonia (Class I, Level of evidence B) (New recommendation). Basic principles of treatment include elevation of the head of the bed to 30 degrees, the use of mild sedation, and avoidance of collar-endotracheal tube ties that might constrict cervical veins. Craniotomy for Posterior Fossa Hemorrhage In cerebellar hemorrhage caused by obstructive hydrocephalus or local mass effect on the brainstem, deterioration can occur quickly due to the narrow confines of the posterior fossa. A meta-analysis of 12 clinical trials suggested superiority of minimally invasive approaches over craniotomy, but methodological issues have been raised with this analysis. The study demonstrated a significant reduction in perihematomal edema in the hematoma evacuation group with a trend toward improved outcomes. Patients with cerebellar hemorrhage who are deteriorating neurologically or who have brainstem compression and/or hydrocephalus from ventricular obstruction should undergo surgical removal of the hemorrhage as soon as possible (Class I, Level of evidence B). The effectiveness of minimally invasive clot evacuation with stereotactic or endoscopic aspiration with or without thrombolytic usage is uncertain. Management of anticoagulant-related intracranial hemorrhage: an evidence-based review. Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion. Venous phase of computed tomography angiography increases spot sign detection, but intracerebral hemorrhage expansion is greater in spot signs detected in arterial phase. Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab.

Wallis Zieff Goldblatt syndrome

Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized anxiety meds purchase phenergan 25mg overnight delivery, double blind anxiety symptoms checklist 90 order 25 mg phenergan visa, placebo controlled study anxiety symptoms journal phenergan 25mg cheap. Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Nasogastric tube feeding in predicted severe acute pancreatitis: a systematic review of the literature to determine safety and tolerance. Clinical trial; oral feeding with a soft diet compared with clear liquid diet as initial meal in mild acute pancreatitis. Treatment of Pancreatic Necrosis the concept of early surgical debridement of pancreatic necrosis has largely been abandoned, as it is associated with increased mortality. Antibiotics alone have been found to effective in a subset of stable patients with infected necrosis. Patients with infected necrosis who do not respond to antibiotics and patients with symptomatic sterile necrosis should be treated with minimally invasive procedures like percutaneous, endoscopic or laparoscopic drainage. Considerable number of these patients may be suffering from a specific cause such as slow colonic transit, fecal evacuation disorder or a combination of these two disorders. In a study from a tertiary level care center in Thailand, of 103 patients with chronic constipation, 30, 14, 11, and 48 patients were diagnosed having anorectal dysfunction, colonic inertia, anorectal dysfunction plus colonic inertia, and normal transit constipation, respectively. In another recent Indian study, of 99 patients with primary chronic constipation, 46, 15, and 40 had normal transit, slow transit constipation, and fecal evacuation disorder, respectively. Maintaining a symptom diary helps in better evaluation of patients, follow-up and assessing response to treatment objectively over a period of time as recall by the patient may not be correct. Lack of adequate physical exercise may also contribute to the severity of constipation. Another important component of history is alarm symptoms such as blood in the stool, unintended weight loss and family history colon cancer. In the presence of alarm symptoms, appropriate investigations should be undertaken to exclude organic diseases such as colon cancer. Physical examination constitutes another important component of evaluation of patients with constipation. Inspection of perianal area at rest and during straining may reveal anal fissure, prolapsing hemorrhoids, rectal prolapse and abnormal perineal descent, some of which may be the cause and others complications of long-standing constipation. Per-rectal examination is very important component and if properly performed, it may give clue to diagnosis of fecal evacuation disorder. On rectal examination, one should assess resting and squeeze tone of anal sphincter, degree of relaxation during attempted defecation, whether pubo-rectalis relaxes or contracts during attempt at defecation, presence of hard stool in the rectum in addition to feeling presence of growth in rectum and blood on the examining finger. During attempted defecation, the examiner should also place a hand on abdominal muscles to feel effectiveness of its contraction. A good per rectal examination performed by an experienced and well-trained doctor may be able to pick-up the diagnosis of 77% patients with pelvic floor disorder confirmed on ano rectal manometry. Similarly, in multiple capsule technique, capsules are taken daily for 3 days followed by abdominal X-rays on day 4 and 7 or only on day 7. However, when such protocols are used in Indian population, all the markers got expelled and hence, transit time could not be calculated. Hence, attempt was made to standardize the protocol by reducing the interval between ingestion of the markers in Indian population. Investigations Colonoscopy is an important investigation, particularly among patients with alarm symptoms; in other patients, it may also detect associated conditions such as hemorrhoids, solitary rectal ulcer, and colonic diverticulosis. Investigations to explore pathophysiology of constipation include colon transit study by radioopaque markers, ano-rectal manometry, balloon expulsion test, and defecography. High-resolution manometr y may be performed using expensive solid-state catheter or less expensive water perfusion catheter. Dyssynergic defecation, which denotes lack of ability to have an adequate recto anal pressure gradient to push out feces, may be of four sub types. Initial protocol for assessment of colon transit time using radiopaque markers described from the West described single or multiple capsule techniques.

Raine syndrome

However anxiety nursing interventions buy phenergan 25mg, lack of storage space and high expense make multiple containers and duplicate equipment impractical anxiety of death order phenergan 25mg otc. Using a length-based tape makes it much simpler to determine the appropriate equipment and medication doses for a child anxiety killing me order phenergan with american express. The device allows you to focus on the patient instead of trying to remember the correct equipment size and drug dose. The length-based tape estimates weight and equipment size better than medical professionals. Although there is some controversy about the accuracy of length-based medication dosages because of the increased incidence of childhood obesity, standard length-based resuscitation systems continue to be recommended as safe, rapid, and accurate tools. Besides length-based systems, there are other methods emergency care providers can use to determine appropriate dosages and equipment sizes. Local medical direction should determine which system an organization will use and ensure all providers are trained. Young children who fall from higher than a few feet often land on their heads because the head is disproportionately large and heavy compared to the body of a small child. Fortunately, when children fall from a height of less than three feet, they rarely sustain serious head injuries. One exception to this rule is infants younger than three months of age, who may be seriously injured from seemingly minor falls. Injuries sustained by children riding bicycles, motorcycles, and dirt bikes, especially if they are not wearing a helmet, are often severe. Motor-vehicle collisions, especially if car seats, booster seats, and lap-belt restraints are improperly used, may result in seat-belt syndrome, which can include life-threatening injuries to the liver, spleen, intestines, or lumbar spine. Other warning flags include a delay in seeking care, if the story about the incident frequently changes during your assessment, if stories vary between parents or caregivers, or if you have any other concerns. Remember to report any of these findings to the emergency department team and/or appropriate local authorities. Sk Ap pe ara nc e When arriving at the scene of an injury, it is very important to quickly assess the situation and the injured child. Before ever touching an injured child, Academy of Pediatrics, to help you efficiently prioritize your care and communicate your findings. Although a preschool child may appear to be sleeping rather than unconscious from an injury, remember that most children will not sleep through the arrival of emergency vehicles. Following a traumatic event, a decreased level of consciousness may suggest hypoxia, shock, head trauma, or seizure. It will help you efficiently prioritize your care and communicate your findings to the emergency department team. Work of Breathing C in irc n tio ula General Assessment Assessment of the Airway As you begin your assessment, stabilize the neck in a neutral position with your hands. For example, neonates are obligatory nose breathers, so clearing the nose with a bulb syringe can be life saving. To use the bulb syringe, first collapse the bulb end of the syringe, and then put the point end in the nose of the child and release the bulb. When you remove the syringe from the nose, squeeze the bulb to empty the mucus, blood, or vomit, and repeat. The bulb syringe can be used to remove secretions from the posterior pharynx of infants as well. Look for signs of airway obstruction in the child, including apnea, stridor, and "gurgling" respirations. Suctioning oral secretions and any vomit from the posterior pharynx also can help. Inserting an oropharyngeal airway may help keep the obstructed airway patent in an unconscious child. Also, remember that in small children, the occiput is rather large compared to the torso. When positioned flat on a spinal immobilization board or stretcher, the occiput will often flex the neck and the floppy upper airway.

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