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Arteriovenous malformations (AVM) of the cervical spine can present with symptoms resulting from their mass effect, vascular steal, or subarachnoid hemorrhage (SAH). While ruptured cerebral aneurysms bleed fast and usually cause severe headache, AVM bleed slowly; moreover, when the location is extracranial, the presentation might be even more confusing. For these reasons, the clinical course can be misleading. We present the case of a woman who had bleeding from an AVM of the cervical spine and discuss the classification and treatment options of AVM. GX15-070 concentration Copyright © 2020, Cox et al.Background Weight estimation during medical emergencies in children is essential, but fraught with errors if the wrong techniques are used, which may result in critical drug dosing errors. Individualised weight estimation is required to allow for accurate dosing in underweight and obese children in particular. This study was designed to evaluate the associations between weight estimations from different systems and body composition in order to establish how and why they may perform well or poorly. Methods A convenience sample of 332 children aged from one month to 16 years had weight estimations using four age-based formulas the Broselow™ Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL), the Mercy Method, and the Pediatric Advanced Weight Prediction in the Emergency Room, Extra-large/Extra-long Tape (PAWPER XL) Tape. They also had an assessment of body composition using dual x-ray absorptiometry (DXA). The weight estimates were compared against total body weight (TBW), calculate © 2020, Wells et al.A 41-one-year-old female on chronic hemodialysis with a medical history of systemic lupus erythematosus and end-stage renal disease presented with clotted hemodialysis access. She was sent to the operating room for angiogram/angioplasty with thrombectomy. Although the thrombectomy was successful, toward the end of the case, she went into cardiac arrest secondary to a massive pulmonary embolization that probably originated from her clotted arteriovenous fistula. Spontaneous circulation returned only after a prolonged period of resuscitation using advanced cardiac life support. She was transferred to the medical intensive care unit (ICU) intubated while receiving minimal cardiovascular pharmacological support. Computerized tomography (CT) scan of the head indicated extensive anoxic brain injury and she expired two days later. Copyright © 2020, Ng et al.In patients with a history of gout, there could be a delay in diagnosis of a septic joint, which increases morbidity and mortality. The literature reports rare instances of coexistent gout and septic arthritis. We present a 64-year-old male with non-ischemic cardiomyopathy, supported by a HeartWare ventricular assist device, who developed a methicillin-resistant Staphylococcus aureus (MRSA) driveline infection four months after device implant. He achieved suppression with minocycline 100 mg by mouth twice a day for five months before presenting to the emergency room with symptoms of gout. Joint aspirate was consistent with a diagnosis of MRSA as well as gout. The patient presented with typical symptoms of a percutaneous driveline infection soreness at the exit site, erythema, and thick, purulent drainage. Wound culture of the driveline confirmed MRSA and guided antibiotic treatment. His presentation was unusual in that sepsis was identified only after he presented with septic arthritis, which led to the collection of blood cultures. He had no fever, chills, nausea, vomiting, or hypotension. This case illustrates that unresolving gout symptoms after one treatment, in a patient with a known driveline infection, should be further evaluated for possible sepsis and septic arthritis. The patient's unusual presentation of sepsis caused difficulties in diagnosis and management. To our knowledge, this is the first reported case of a driveline infection seeding a joint and causing septic arthritis. Copyright © 2020, Toms et al.An infected diaphyseal forearm nonunion can be a challenge. After several failed salvage procedures, the patient can be left with residual pain, shortening, bone loss, and poor soft tissue envelope. Keystones for infected nonunion treatment are debridement, cultures, antibiotics, stability, and restore alignment. This report describes the current literature on the treatment of forearm nonunion, and we present a case of a recalcitrant infected ulna nonunion that ultimately healed after 12 surgeries. Copyright © 2020, Bech et al.Introduction Key skills required of today's students include critical thinking, problem-solving, creativity, innovation, collaboration, and communication. The acquisition of these skills is foundational to success in a variety of professions and contexts. This study complements a larger simulated person methodology (SPM) project that utilizes simulators (individuals who are trained to realistically reproduce scenarios by providing specific information, displaying signs and behaviours, and creating a realistic encounter in a consistent manner) to replicate real workplace issues, thus affording students an opportunity to apply knowledge and practice real-life skills necessary to the workplace. The primary objective of this study is to apply this innovative teaching approach in higher education as a means of developing proficient critical-thinking and interpersonal skills. Methods This pilot study uses an exploratory mixed-methods design to explore the experiences of 12 students enrolled in an athletic therapy (AT) certificate program that uses SPM. Our hypothesis is that SPM will have a positive impact on student learning and professional development. Results The students responded favourably to the use of SPM. Indeed, 80% "felt challenged and stimulated" and deemed SPM to be a "more effective method" of practicing communication skills than practicing with fellow students. These findings can inform future research and support work towards enhancing this methodology as a pedagogical approach. In tandem, this study and the larger SPM project are poised to provide an effective undergraduate education experience across various faculties at the pilot university. More work is required to align this teaching approach with the AT education program redesign. Copyright © 2020, Peisachovich et al.
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