- Abdominal radiographs to diagnose functional constipation in pediatric patients not indicated.
- In unreliable pediatric patients, plain abdominal radiography may be useful.
- PEG is recommended as first-line maintenance treatment for functional constipation.
Latest Updates
Blunt Cerebrovascular Injuries
- Multislice (> 64 slice) computed tomographic angiography is the routine imaging test performed to identify blunt cerebrovascular injury (BCVI).
- With noninvasive imaging used for BCVI identification, screening criteria have recently been expanded.
- Antithrombotic treatment almost universally prevents BCVI-related stroke.
- Endovascular therapy for BCVI should be reserved for those patients who are markedly symptomatic from their injury or have an enlarging pseudoaneurysm on repeat imaging.
Overview Of Schizophrenia And Other Psychotic Disorders
- Psychotic disorders have been reclassified by grouping together those considered to fall within a schizophrenia spectrum.
- Delusional disorder no longer requires the presence of nonbizarre delusions.
- Schizophrenic subtypes (paranoid, disorganized, catatonic) were discontinued in the DSM-5. 2020 APA practice guidelines to be published.
Mechanical Ventilation: Advanced Ventilation and Adjuncts
- The use of prone positioning to improve the outcome in patients with acute respiratory distress syndrome
- The use of neuromuscular blockade in patients with severe acute respiratory distress syndrome
- High-flow nasal cannula therapy as a possible alternative to noninvasive positive-pressure ventilation
- Evidence for efficacy of a recently approved second-generation triazole (isavuconazole)
- Enhanced understanding of the characteristics of and indications for currently available antifungals
- Because fluconazole interacts with warfarin, phenytoin, and cyclosporine when given in a daily dose of 200 mg or higher, serum concentrations of these agents should be monitored when they are used in conjunction with fluconazole.
Mechanical Ventilation: Respiratory Physiology and Conventional Ventilation
- Berlin Modification of the definition of ARDS and PaO2/FIO2 ratio into mild (P/F < 300), moderate (P/F ratio < 200) and severe (P/F < 100)
- The first ventilator, the iron lung, was developed in 1928 and extensively used in the 1940s during the polio epidemics. Nearly all current mechanical ventilators are positive-pressure ventilators; one negative-pressure ventilator is available but is primarily used for pulmonary toilet in patients with cystic fibrosis.
- On a mechanical level, increases in PEEP move the zero-pressure point (ZPP) more proximally within the airway. Optimal PEEP is the PEEP that places the ZPP within a cartilaginous portion of the airway instead of a more distal, collapsible segment.
Mechanical Ventilation: Approaches and Special Considerations
- Consideration for specific ventilator modes for those at risk of acute respiratory distress syndrome (ARDS)
- The use of respiratory therapist–guided spontaneous breathing trials
- Changes in the pattern of tracheostomy use for acute respiratory failure
- Expanded penetrance of palliative care in those with prolonged mechanical ventilation
- The expanded use of extracorporeal techniques for severe ARDS
- Development of guidelines for diagnosis and treatment of diabetic foot to help codify worldwide data across various specialties involved with diabetic foot
- Using a specialized sealed dressing and a vacuum pump, the wound vacuum is a therapeutic system that implements a constant or intermittent negative pressure environment to accelerate wound healing in acute and chronic wounds
- After successful revascularization, secondary procedures on the foot may be performed for maximal foot salvage, with the aim of addressing both the acute problem and the underlying cause. The basic goals of such procedures are to (1) remove infected bone (if present), (2) restore functional stability, and (3) reduce the risk of subsequent ulceration
