What's New | Decker

To recognize and treat important cardiac arrhythmias in the surgical patient using the latest advances
Most up to date guidelines in management of Acute Coronary Syndrome (ACS) in Surgical Patients
Recent progress in management ofheart failure in postoperative and traumatic patients

Contemporary understanding of ventricular mechanics with identification of the structure and function of the ventricular myocardial band
Detailed description of the anatomic proximity of cardiac structures and how knowledge of this proximity helps prevent intraoperative complications and damage to critical cardiac structures
Comprehensive description of aortic root anatomy and mechanics and application of how this anatomy dictates performance of transcatheter aortic valve replacement

Most grade III and IV injuries, including those with devitalized parenchymal fragments and urinary extravasation, are managed nonoperatively
Angioembolization of persistent or delayed kidney bleeding (pseudoaneurysm) obviates the need for exploration in a majority of cases
A high index of suspicion is necessary to diagnose a ureteral injury to prevent late complications such as urinoma, sepsis, and nephrectomy

Early recognition of shock is difficult but essential for preservation of cellular and organ function and survival. The earliest clinical signs are nonspecific, with the initial inflammatory response including tachycardia, fevers, or cool or clammy skin.
The approach to shock ultimately requires understanding and correcting its etiology (eg, antibiotics and source control for sepsis, thrombectomy after massive pulmonary embolus, hemorrhage control after trauma, and so forth). However, until these are diagnosed and addressed directly, clinicians ultimately have three approaches in their armamentarium: volume expansion, vasopressors, and cardioactive agents.
The PAC was introduced in 1970. Its use increased over the next 3 decades and eventually was considered the standard of care for most critically ill patients. However, the use of PACs declined rapidly after the results of the randomized, controlled trial published in the New England Journal of Medicine revealing no benefit in high-risk surgical patients.

2024 KDIGO Practice Guidelines
Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada
Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

2024 KDIGO Practice Guidelines
Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada
Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

The contribution of genetics to Parkinson disease (PD) is suggested by the increased risk of disease associated with a family history, and community-based studies that found a 1.5- to threefold increased risk of PD in persons with an affected first-degree relative. However, the most convincing evidence to date has come with the discovery of monogenic forms of PD. Highly penetrant mendelian forms of PD have now been associated with mutations in different genes but, in most populations, causative mutations in these genes have been found in fewer than 5% of patients. Nevertheless, different variants with incomplete penetrance in the LRRK2 and the GBA gene are strong risk factors for PD, and are especially prevalent in some populations. Mutations of the GBA gene are indeed the most important risk factor yet discovered for PD; the presence of a GBA mutation in homozygous or heterozygous form is associated with an approximately 20-fold increase in the risk for PD.

The recent Food and Drug Administration–approved drug Rytary is a novel designed capsule and delivery system containing both standard- and extended-release levodopa/carbidopa components that were designed to reduce the number of dosages taken per day. A recent randomized, double-blind, placebo-controlled study of Rytary in levodopa-naïve Parkinson disease (PD) patients showed significant improvements in the Unified Parkinson Disease Rating Scale and in quality of life measurements at 30 weeks compared with placebo. Rytary will need time in clinical practice to better define its role in therapy.

Critical Care