This document discusses cervical spine injuries. It begins by providing epidemiological data on cervical spine injuries, including common causes, levels of injury, and classifications of complete vs incomplete spinal cord injuries. It then discusses neurological assessment techniques, airway management considerations, importance of breathing and circulation support, clinical criteria for clearing the cervical spine, and immobilization guidelines. Recommendations are provided for tracheal intubation methods, criteria for cervical spine imaging, and guidelines for cervical spine clearance. Early removal of cervical collars is also recommended to reduce complications.
Initial resuscitation of patients with upper GI bleeding is critical and includes IV access, oxygen, fluid resuscitation, and blood product transfusion if needed. Early risk stratification evaluates factors like age, comorbidities, hemodynamic stability, and endoscopic findings to determine risk of rebleeding, need for intervention, and mortality. Source of bleeding is identified through endoscopy within 24 hours when possible. For low risk patients, medical therapy with PPIs is usually sufficient, while high risk patients may require endoscopic treatment or radiologic intervention. High dose PPIs, especially IV formulations, are effective in preventing rebleeding and shortening hospital stays when given before and after endoscopy. Surgery is reserved for
The Thai National HIV Guidelines Working Group updated treatment guidelines for pediatric HIV in March 2010. Key aspects include:
1) ART should be initiated in infants <12 months regardless of symptoms and all children with CDC stage B/C or WHO stage 3/4 disease. CD4-guided thresholds are provided for mildly symptomatic children.
2) The preferred first-line regimen for children <3 years is AZT+3TC+NVP. For children >3 years it is AZT+3TC+EFV. Consider TDF+3TC+EFV for adolescents weighing >40kg.
3) The preferred second-line regimen for first-line failure comprises 2NRTI+LPV/r.
The document provides guidelines for antiretroviral therapy (ART) for HIV-1 infected adults and adolescents in Thailand. Key points include:
- ART is now recommended to start at a CD4+ T-cell count of <350 cells/mm3.
- The preferred first regimen is a non-nucleoside reverse transcriptase inhibitor (NNRTI) such as efavirenz or nevirapine combined with lamivudine and either zidovudine or tenofovir.
- Guidelines were updated based on recent evidence and considerations for the Thai setting and available drugs.