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Intravenous (IV) fluids are a cornerstone of modern medicine, used extensively in hospitals for resuscitation, maintenance, and replacement therapy. Normal saline (0.9% sodium chloride) has been the most commonly used IV fluid worldwide for decades. However, recent research has raised concerns about its potential adverse effects, particularly its high chloride content, which can lead to hyperchloremic acidosis and kidney injury.  In response, balanced crystalloid solutions, such as lactated Ringer's and Plasma-Lyte, have gained attention as potentially safer alternatives. This article explores the findings of recent trials comparing balanced crystalloids to conventional IV fluids.  While widely used the problem with Normal Saline is that it has a chloride concentration significantly higher than that of human plasma. This can disrupt the body's acid-base balance, leading to hyperchloremic metabolic acidosis, a condition associated with renal vasoconstriction, reduced glome...

  Shoulder joint dislocation can be reduced by a lot of explained maneuvers. Its better to learn them through some good videos from open source (YouTube and Vimeo) rather than memorizing  The various maneuvers for the reduction of a Dislocated Shoulder Joint are     1. Kochers Maneuver     2. FARES (Fast Reliable and Safe Technique)     3. Hennepin Technique (External Rotation Technique)     4. Milch Technique     5. Stimsons Technique (Gravitational Weight)     6. Hippodratic and Modified Hippocratic Technique     7. Cunningham Technique Kochers Maneuver Adduction-ExtRotation-Flexion-Internal Rotation The process must be very slow and its better to give some muscle relaxant and analgesic prior to the procedure. Cunningham Technique https://www.youtube.com/watch?v=HGIjEEg_PQQ FARES (FAst, REliable and Safe Technique) Small occilating movements while in extension and external rotation. Gradually this is incre...

 

Targeted Temperature Management in Post-Cardiac Arrest Patients: Insights from Recent Trials Targeted Temperature Management (TTM) has been a cornerstone in the management of comatose patients after cardiac arrest, aimed at improving neurological outcomes by mitigating ischemia-reperfusion injury. Over the past decade, several key trials have sought to refine the understanding of TTM’s effectiveness, optimal temperature targets, and its role in contemporary clinical practice. This article reviews the major recent trials, their findings, and the current recommendations on TTM. 1. HACA Trial (2002) Overview: The Hypothermia After Cardiac Arrest (HACA) trial was one of the earliest studies to demonstrate the benefits of TTM. It evaluated the effect of induced hypothermia (32°C to 34°C) in comatose survivors of out-of-hospital cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia. Findings: Improved neurological outcomes at 6 months in the hypothermia group (...

 The use of steroids, particularly high-dose methylprednisolone (MP), in the treatment of acute spinal cord injury (SCI) has been extensively studied and remains a topic of debate. The primary goal of administering steroids post-injury is to mitigate secondary damage by reducing inflammation and oxidative stress. However, the efficacy and safety of this approach have been questioned. Key Clinical Trials and Findings: National Acute Spinal Cord Injury Study (NASCIS) II (1990): This randomized controlled trial evaluated the effects of high-dose MP administered within 8 hours of injury. A subgroup analysis suggested a modest improvement in motor function scores for patients treated within this time frame. However, the clinical significance of this improvement has been debated, and concerns about methodological limitations were raised. TheNNT NASCIS III (1997): This study compared 24-hour and 48-hour MP infusion protocols. The results did not demonstrate a significant benefit in neur...

As of January 2025, the FINISHER (Fight INflammation to Improve Outcome after aneurysmal Subarachnoid HEmorRhage) trial is ongoing, and its final results have not yet been published. Place: Berlin, Germany The study is designed to assess whether dexamethasone, an anti-inflammatory glucocorticoid, can improve outcomes in patients who have suffered an aneurysmal subarachnoid hemorrhage (aSAH). T he trial is a multicenter, prospective, randomized, double-blinded, placebo-controlled phase III study. It plans to enroll 334 patients, who will be randomized to receive either dexamethasone or a placebo within 48 hours after the hemorrhage.  The dexamethasone regimen consists of 8 mg three times daily for the first seven days, followed by 8 mg once daily from days eight to twenty-one.  The primary outcome measure is the modified Rankin Scale (mRS) at six months, dichotomized to favorable (mRS 0-3) versus unfavorable (mRS 4-6) outcomes. Source: Pub Med and Clinical Trials.gov.in  G...