Professor David Nutt, a former chief drugs adviser to the British government, asked drug-harm experts to rank 20 drugs (legal and illegal) on 16 measures of harm to the user and to wider society, such as damage to health, drug dependency, economic costs and crime. Alcohol is the most harmful drug in Britain, scoring 72 out of a possible 100, far more damaging than heroin (55) or crack cocaine (54). It is the most harmful to others by a wide margin, and is ranked fourth behind heroin, crack, and methamphetamine (crystal meth) for harm to the individual
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Background Various methods have been used to try to protect kidney function in patients undergoing surgery. These most often include pharmacological interventions such as dopamine and its analogues, diuretics, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, N -acetyl cysteine (NAC), atrial natriuretic peptide (ANP), sodium bicarbonate, antioxidants and erythropoietin (EPO). Objectives This review is aimed at determining the effectiveness of various measures advocated to protect patients' kidneys during the perioperative period. We considered the following questions: (1) Are any specific measures known to protect kidney function during the perioperative period? (2) Of measures used to protect the kidneys during the perioperative period, does any one method appear to be more effective than the others? (3) Of measures used to protect the kidneys during the perioperative period,does any one method appear to be safer than the others? Search me...
The traditional end-points of resuscitation (improved LOC, skin perfusion, VS to baseline, UOP, and normal lab values) are DEAD. The new end-points of resuscitation for the trauma/bleeding patient are: Normal TEG (thromboelastography ) Normal pH Normothermia In the next post we will discuss the TEG directed resuscitation ....
Background and Objectives: A test dose containing epinephrine is routinely used during epidural blockade to detect accidental intravenous needle or catheter placement before the administration of local anesthetics to avert local anesthetic systemic toxicity. β-Blocker therapy may interfere with the expected hemodynamic response from an intravascular injection. This study describes a cohort of 24 patients and their response to an epinephrine test dose (ie, if expected increased heart rates during test-dose administration are valid in this population.) Methods: Twenty-four nonsedated, chronically β-blocked patients were enrolled in a prospective, order-randomized, crossover, double-blind study with injections of both placebo and a 15-μg epinephrine test dose in each individual. After injection into a peripheral vein, we observed blood pressure and pulse rate for 5 minutes, injected the other remaining solution (placebo or epinephrine), and observed hemodynamic parameters in the same...
Prior cesarean delivery and the presence of placenta previa in a current pregnancy are particularly important risk factors for placenta accreta. In a multicenter study of more than 30,000 patients who had cesarean delivery without labor, the risk of placenta accreta was approximately 0.2%, 0.3%, 0.6%, 2.1%, 2.3%, and 7.7% for women experienc- ing their first through sixth cesarean deliveries, respectively. In patients with placenta previa in the current pregnancy, the risk of accreta was 3%, 11%, 40%, 61%, and 67% for those undergoing their first through their fifth or greater cesarean deliveries, respectively 1-Silver RM, Landon MB, Rouse DT, Leveno KJ, Song CY, Thom EA, et al. Maternal morbidity associated with mul- tiple repeat cesarean delivery. Obstet Gynecol 2006;107: 1226–32. (Level II-2)