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In victims of in-hospital pediatric cardiac arrest, the cause of the arrest was ventricular fibrillation or tachycardia in only about one quarter of the children, and the others had nonshockable rhythms. The outcome was best when ventricular fibrillation or tachycardia was the initial rhythm and worst if ventricular fibrillation or tachycardia developed later during the resuscitation.
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Obesity is a known risk factor for gastroesophageal reflux disease. Among more than 10,000 women enrolled in the Nurses' Health Study, body-mass index was associated with symptoms of gastroesophageal reflux in both normal-weight and overweight women. Weight gain was associated with symptoms of reflux, even in women with a normal body-mass index at baseline.
In this study of Medicare patients enrolled in the Kaiser Permanente managed-care program in 2003, patients had either individual insurance with a $1,000 annual cap on drug coverage or employer-supplemented insurance with no cap. The drug cap was associated with lower pharmacy costs, higher hospital costs, and similar overall costs. Drug adherence and control of blood pressure, blood lipid levels, and blood glucose levels were poorer among patients with the $1,000 cap.
A 30-year-old woman, recently divorced, presents with daily episodes of chest pain, shortness of breath, sweating, and palpitations. She feels very anxious when these episodes occur and worries about having a heart attack. She reports increasing avoidance of social activities, moodiness, poor sleep, and a low level of energy. She takes no medications and reports no drug or alcohol use. Her physical examination is normal. How should this case be managed?
Blood pressure is inherently variable, and ambulatory measurements of blood pressure predict clinical outcomes better than do conventional, clinic-based measurements. Ambulatory monitoring can help identify “white-coat” hypertension, as well as patients whose blood pressure does not decrease the normal amount during the night. Ambulatory blood-pressure monitoring is practical, can lead to a reduction in health care costs, and can provide improved estimates of true blood pressures to guide decisions about treatment.
A 35-year-old man with advanced AIDS presented to the emergency department after a witnessed syncopal event. He felt light-headed after walking from the bathroom to his chair. While speaking to his partner, he suddenly became unresponsive and lost motor tone, and his breathing appeared shallow and labored, prompting his partner to call 911. He regained consciousness after approximately two minutes and had no recollection of the event. There was no evidence of tonic–clonic seizure activity or postictal confusion.
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