What's New | Decker

Disorders of water and sodium balance are among the most common in the clinical setting and require a clear understanding of osmolality.
Hyponatremia is defined as plasma sodium concentration falling below 135 mEq/L.
Acute hyponatremia has been associated with postoperative complications, oxytocin infusions, cyclophosphamide infusions, exercise, and water intoxication (eg, methylenedioxymethamphetamine).
Chronic hyponatremia can be found in hypovolemic (eg, diarrhea, diuretics, hypoaldosteronism), euvolemic (eg, SIADH, AIDS, hypothyroidism), and hypervolemic states (eg, renal failure, cirrhosis).

Disorders of water and sodium balance are among the most common in the clinical setting and require a clear understanding of osmolality.
Hyponatremia is defined as plasma sodium concentration falling below 135 mEq/L.
Acute hyponatremia has been associated with postoperative complications, oxytocin infusions, cyclophosphamide infusions, exercise, and water intoxication (eg, methylenedioxymethamphetamine).
Chronic hyponatremia can be found in hypovolemic (eg, diarrhea, diuretics, hypoaldosteronism), euvolemic (eg, SIADH, AIDS, hypothyroidism), and hypervolemic states (eg, renal failure, cirrhosis).

Labor pain is a complex entity, and no single therapy is right for all patients.
Inhalation of nitrous oxide and intramuscular/intravenous opioids provide mild to moderate pain relief with side effects of nausea and sedation.
The development of low-dose epidural medications has decreased the side effects of this modality while still providing excellent pain relief.
Short-acting, lipophilic opioids administered by patient-controlled analgesia can provide good pain relief for many patients.
Providing analgesic medications, whether inhalational, intramuscular/intravenous, or neuraxial, does not affect the duration of labor or the mode of delivery in randomized studies.

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

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

Two new tests are now available: thromboelastography and the thrombin generation test.
Both assays provide much more information than the conventional clotting times
New generations of devices allow both tests to be performed in an automated manner, leading to greater reproducibility and less variation among laboratories.

The initial assessment of the patient with suspected AHF should focus on immediate life-threatening conditions. Careful attention should be paid to vital signs. Hypoxia should be treated with supplemental oxygenation and may be a marker for impending respiratory failure. The history should help ascertain possible causes of exacerbation of HF, as well as risk factors or symptoms suggestive of HF mimics.
Nesiritide is a recombinant BNP that, similar to NTG, is a venous, arterial, and coronary dilator. Several early trials demonstrated improved hemodynamics with nesiritide, with a suggestion of some clinical benefit. However, data from these trials failed to demonstrate a mortality benefit and questions arose about the possibility of increased renal insufficiency and worse mortality with its use.
Sodium nitroprusside can be similarly used to decrease both preload and afterload. Observational data have suggested a mortality benefit in AHF patients treated with nitroprusside, but randomized trial data appear to be limited to patients with acute myocardial infarction and have not been able to demonstrate a mortality decrease.

The initial assessment of the patient with suspected AHF should focus on immediate life-threatening conditions. Careful attention should be paid to vital signs. Hypoxia should be treated with supplemental oxygenation and may be a marker for impending respiratory failure. The history should help ascertain possible causes of exacerbation of HF, as well as risk factors or symptoms suggestive of HF mimics.
Nesiritide is a recombinant BNP that, similar to NTG, is a venous, arterial, and coronary dilator. Several early trials demonstrated improved hemodynamics with nesiritide, with a suggestion of some clinical benefit. However, data from these trials failed to demonstrate a mortality benefit and questions arose about the possibility of increased renal insufficiency and worse mortality with its use.
Sodium nitroprusside can be similarly used to decrease both preload and afterload. Observational data have suggested a mortality benefit in AHF patients treated with nitroprusside, but randomized trial data appear to be limited to patients with acute myocardial infarction and have not been able to demonstrate a mortality decrease.

Endocrinology and Metabolism