What's New | Decker

CT of the chest has taken a greater role in determining injury severity in inhalation injury.
Airway control and ventilator management remain the mainstays of treatment in those with severe injury.
Volumetric diffusive respiration is a mode specifically developed for inhalation injury that has been shown to decrease use of other rescue modes of ventilation.

Pulmonary hypertension can be treated with single or combination therapy employing calcium channel blockers, phosphodiesterase inhibitors, guanylate cyclase stimulators, endothelin receptor antagonists, and prostanoids.
Levosimendan is a calcium sensitizer used to treat cardiogenic shock and right heart failure.
Clevidipine is an ultra-rapid acting calcium channel blocker used for perioperative hypertension management in cardiovascular and vascular diseases, neurosurgery, and surgery for pheochromocytoma.

The two leading classification systems for diagnosing mental illness are the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association and the ICD-10, the most recent edition of the International Classification of Diseases published by the World Health Organization.
There is no standard medical workup for a patient presenting with depression. Health care providers use their clinical judgment in conjunction with a good history, review of medical systems, and physical examination. Indiscriminate ordering of laboratory tests in depressed patients rarely yields useful results. A pooled analysis of psychiatric inpatients showed the rates of clinically significant laboratory findings to be remarkably low.
Single-photon emission CT (SPECT) has been promoted by some as a reliable tool in diagnosing and treating a number of psychiatric disorders, including depression. SPECT measures regional cerebral blood flow using a gamma-emitting tracer in the blood.

The number of permanent pacemakers implanted per year increased by 55.6% between 1993 and 2009, and is continuing to rise. Accordingly, the number of patients treated in the emergency department who have permanent pacemakers is increasing, and it is important for physicians in the emergency department to be familiar with the operation and potential complications of these devices.
Genetic testing of first-degree relatives is recommended according to 2018 ACC/AHA/HRS guidelines on evaluation of bradycardia and conduction delay.
Permanent pacing is reasonable intervention for patients with tachy-brady syndrome and symptoms attributable to bradycardia.
2018 ACC/AHA/HRS specific guideline considerations for genetic disorders, neuromuscular disorders, and infiltrative disorders (e.g., cardiac sarcoidosis and amyloidosis).

Radiofrequency ablation as a treatment modality has revolutionized therapy for many SVTs; acts as a first-line alternative to drug therapy in some circumstances, with a high acute success rate and relatively low complication rate.
Cryoablation therapy emerging as an alternative in ablative therapies. Investigation of this modality for SVTs is ongoing.
Detailed drug regimens optimized for acute and chronic management of specific SVTs; detailed in the 2015 ACC/AHA/HRS practice guidelines.

The REVERT trial concluded that a modified valsalva maneuver has a higher rate of cardioversion than historical vagal maneuvers.
In a patient with stable SVT where vagal maneuvers have failed, IV adenosine remains the first-line pharmacologic agent.
Combining adenosine and saline in a single syringe, rather than administration of adenosine followed by a saline flush, has been proven to be an effective form of administration.

Sepsis syndromes have been redefined (Sepsis-3 definitions) by international experts, based on sepsis mortality data extracted large administrative databases.
National focus has turned to early identification of sepsis as a key determinant of outcomes. International critical care experts have recommended using the qSOFA criteria in the Emergency Department setting to identify sepsis risk in patients prior to obtaining diagnostics.
The Center for Medicare and Medicaid Services (CMS) has added a sepsis quality measure (SEP-1) as a reporting requirement for all US hospital tied to Medicare & Medicaid reimbursement. This measure has increased awareness of sepsis performance and focused quality efforts on improvement.
2018 update to bundles to simplify to 1-hour bundle.

Although borderline personality disorder has traditionally been perceived as difficult or impossible to treat, significant progress has been made in developing and validating treatments.
Specialized psychotherapy remains the treatment of choice.
Short-term or stepped care interventions may represent a more efficient treatment model.
Common factors, such as structured therapies, may be nearly as effective as specialized treatments.
Pharmacotherapy plays a limited role in treatment.

Burns