- BTAI is now the gold standard n treating patients with these problems
- The grade of injury with these lesions has been defined and there is controversy on which lesion should be treated and how emergently
- Recently in the US a device changed its IFU because of complications after TEVAR for BTAI. It was being used outside its IFU.
- Recent advancement on sizing and device differences between BTAI and other pathologies treated with TEVAR
Latest Updates
- Spirometry has few absolute contraindications, although several conditions should merit caution and others may affect the quality of results. Pain, nausea, or other subjective discomforts, as well as altered mental status, will likely lead to poor results and therefore are relative contraindications.
- The role of the carbon monoxide (CO) diffusing capacity (DLCO) test is to provide information on the transfer of gas from alveolar air to the bloodstream. DLCO reflects the overall efficiency of gas movement at each step from the mouth to the hemoglobin in the pulmonary capillary blood.
- Certain substances and behavior should be avoided prior to testing as they can lead to either false positives or false negatives. Recent upper respiratory tract infection and cigarette smoking can elevate bronchial hyperresponsiveness.
Complementary and Alternative Medicine: Is It Alternative or Mainstream for Managing Low Back Pain?
- Complementary and alternative medicine therapies are now an important part of the management of chronic low back pain in patients.
- Physical modalities such as yoga and tai chi aim for a mind-body connection effect to help treat chronic low back pain.
- Acupuncture has been shown in some medical studies to be of benefit with chronic pain when combined with conventional treatments.
- Herbal medicines are increasingly being used by patients to treat back pain. Regulation of this industry is required to ensure the safety and reliability of these agents.
- Medical marijuana is being advocated by many for chronic low back pain; at present, research is not conclusive on the benefit of this herbal. Further research is required prior to universal recommendation.
Management of Shock in Infants and Children
- Extracorporeal membrane oxygenation (ECMO) is a modified method of cardiopulmonary bypass that is used as a last resort modality for support of the pediatric patient in cardiac and/or respiratory failure.
- VADs are a newer, alternative method of mechanical circulatory support for children in refractory heart failure or cardiogenic shock who are awaiting transplantation. VAD use in adults is well established, and its use in children has been steadily increasing over the last decade.
- Lactate is a by-product of anaerobic metabolism and is often used to diagnose and monitor the progression of shock. Although lactate is less frequently elevated in pediatric patients, an initial elevated lactate level has been found to be associated with increased risk of organ dysfunction in pediatric sepsis and can be followed as a marker of resuscitation.
- Surgical treatment of uncomplicated type B aortic dissection
- Endovascular techniques for malperfusion syndrome
- Standard practice of intravascular ultrasonography
- Importance of false lumen thrombosis
- Maneuvers to decrease the risk of spinal cord ischemia in open aortic surgery
Initial Management of Life-Threatening Trauma
- Initial volume resuscitation should commence with 1 L isotonic crystalloid solution followed by blood products at 1:1:1 ratio (1 unit packed red blood cells to 1 unit fresh frozen plasma to 1 unit platelets) if the patient is not responsive to the initial fluid bolus.
- In patients with massive hemorrhage or evidence of fibrinolysis, tranexamic acid has demonstrated improved survival if administered within 3 hours of injury.
- Use of resuscitative endovascular balloon occlusion of the aorta may be an important adjunct in the control of life-threatening abdominal or pelvic hemorrhage.
- In cases of external hemorrhage of an extremity, a tourniquet should be used to control bleeding.
Approach to the Geriatric Patient
- 2016 EAST practice management guideline on prevention of fall-related injuries in the elderly
- 2016 CTF on Preventive Health Care recommendations on screening for cognitive impairment in older adults
- 2016 USPSTF recommendation statement on screening for depression in adults
- 2015 AGS Beers criteria for potentially inappropriate medication use in older adults
- 2016 AAO preferred practice guideline on comprehensive adult medical eye evaluation
- Spirometry has few absolute contraindications, although several conditions should merit caution and others may affect the quality of results. Pain, nausea, or other subjective discomforts, as well as altered mental status, will likely lead to poor results and therefore are relative contraindications.
- The role of the carbon monoxide (CO) diffusing capacity (DLCO) test is to provide information on the transfer of gas from alveolar air to the bloodstream. DLCO reflects the overall efficiency of gas movement at each step from the mouth to the hemoglobin in the pulmonary capillary blood.
- Certain substances and behavior should be avoided prior to testing as they can lead to either false positives or false negatives. Recent upper respiratory tract infection and cigarette smoking can elevate bronchial hyperresponsiveness.
