Objectives: To map current practice regarding discussions around resuscitation across England and Scotland in patients with cancer admitted acutely to hospital and to demonstrate the value of medical students in rapidly collecting national audit data.
Methods: Collaborators from the Macmillan medical student network collected data from 251 patient encounters across eight hospitals in England and Scotland. Data were collected to identify whether discussion regarding resuscitation was documented as having taken place during inpatient admission to acute oncology. As an audit standard, it was expected that all patients should be invited to discuss resuscitation within 24 hr of admission.
Results: Resuscitation discussions were had in 43.1% of admissions and of these 64.0% were within 24 hr; 27.6% of all admissions. 6.5% of patients had a "do not attempt resuscitation" order prior to admission with a difference noted between patients receiving palliative and curative treatment (8.5% and 0.39%, respectively, p < .05). Discussions regarding escalation of care took place in only 29.3% of admissions.
Conclusions: These data highlight deficiencies in the number of discussions regarding resuscitation that are being conducted with cancer patients that become acutely unwell. It also demonstrates the value of medical student collaboration in rapidly collecting national audit data.
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http://dx.doi.org/10.1111/ecc.13218 | DOI Listing |
Curr Cardiol Rep
January 2025
Department of Cardiovascular & Thoracic Surgery, Sandra Atlas Bass Heart Hospital at North Shore University Hospital, Northwell Health, 300 Community Drive, 1 DSU, Manhasset, NY, 11030, USA.
Purpose Of Review: This article discusses a tailored approach to managing cardiogenic shock and temporary mechanical circulatory support (tMCS). We also outline specific mobilization strategies for patients with different tMCS devices and configurations, which can be enabled by this tailored approach to cardiogenic shock management.
Recent Findings: Safe and effective mobilization of patients with cardiogenic shock receiving tMCS can be accomplished.
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View Article and Find Full Text PDFAnaesthesia
January 2025
Department of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, USA.
Introduction: Immunotherapy has transformed cancer treatment, particularly with immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy. Despite their efficacy, these therapies can induce cardiotoxicity, presenting significant clinical challenges. Immune checkpoint inhibitors can cause myocarditis; pericarditis; arrhythmias; and myocardial infarction through immune-mediated inflammation.
View Article and Find Full Text PDFBMJ Case Rep
January 2025
Accident and Emergency, Birmingham Heartlands Hospital, Birmingham, UK.
Heat stroke is characterised by hyperthermia and acute encephalopathy. We describe a rare case of classical heat stroke secondary to prolonged sauna use with multiorgan sequelae including seizures, liver injury, kidney injury, disseminated intravascular coagulation, rhabdomyolysis and type 2 myocardial infarction. The patient was treated with external cooling, intravenous fluid therapy and blood products, and made a full recovery without need for advanced organ support.
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Emergency Medicine, Freeman Health System, Joplin, MO 64804, USA.
Sodium bicarbonate has been used in the treatment of different pathologies, such as hyperkalemia, cardiac arrest, tricyclic antidepressant toxicity, aspirin toxicity, acute acidosis, lactic acidosis, diabetic ketoacidosis, rhabdomyolysis, and adrenergic receptors' resistance to catecholamine in patients with shock. An ongoing debate about bicarbonate's efficacy and potential harm has been raised for decades because of the lack of evidence supporting its potential efficacy. Despite the guidelines' restrictions, sodium bicarbonate has been overused in clinical practice.
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