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The Seizure Type Clas is highly iterative and involves initial production of the doc sification is determined according to women's health center newark beth israel hospital cheap danazol 100 mg line the new nomenclature 10 ument by a group of experts selected by the League menstruation knee pain discount danazol 100 mg visa, posting in the accompanying paper women's health clinic johnson county cheap danazol 50 mg otc. In conducted by the journal to menstrual migraine headaches buy genuine danazol on line which the document is submit other cases, there may simply be too little information avail ted for publication. The emphasis was on that the patient has a diagnosis of epilepsy based on the 31 employing transparent terminology, where words mean 2014 definition. The 2010 publication triggered extensive dis category of Combined Generalized and Focal Epilepsy in 1229 cussion and commentaries. A new Commission on addition to the well-established Generalized Epilepsy Classification and Terminology was subsequently and Focal Epilepsies. Many epilepsies will include multiple types of revised Classification through the procedure outlined for seizures. The Commission submitted the For a diagnosis of Generalized Epilepsy, the patient initial document in 2013, and the document was posted would typically show generalized spike-wave activity on Epilepsia, 58(4):512521, 2017 doi: 10. In this case, supportive evi would therefore have a diagnosis of Combined Generalized dence would need to be present to make a diagnosis of gen and Focal Epilepsy. A range eralized because there is insufficient information avail of seizure types can be seen including focal aware seizures, able. An Common examples in which both types of seizures occur epilepsy syndrome refers to a cluster of features incorporat are Dravet syndrome and Lennox-Gastaut syndrome. It often has age-dependent features such as achievable where the clinician is unable to make an Epi age at onset and remission (where applicable), seizure trig 4,5 lepsy Syndrome diagnosis. It may have associated etiologic, ized tonicclonic seizures and generalized spike-wave prognostic, and treatment implications. There are many well recognized syndromes, such as childhood absence epilepsy, Self-limited focal epilepsies West syndrome, and Dravet syndrome, although it should There are several self-limited focal epilepsies, typically be noted that there has never been a formal classification of beginning in childhood. Other self-limited frontal lobe, temporal, and parietal 36 lobe epilepsies have been described with some beginning Idiopathic Generalized Epilepsies in adolescence and even adult life. A range of etio and Generalized TonicClonic Seizures Alone (formerly logic groups has been recognized, with emphasis on those known as Generalized TonicClonic Seizures on Awaken that have implications for treatment. This enables the clinician to decide if there pathic from the nomenclature of Epilepsy Classification is a structural etiology for the patients epilepsy. The five was suggested, as its definition was no known or suspected additional etiologic groups are genetic, infectious, meta 4 etiology other than possible hereditary predisposition. A the Greek term idios refers to self, own, and personal, patients epilepsy may be classified into more than one etio and is thus meant to reflect the genetic etiology without logic category; the etiologies are not hierarchical, and the explicitly saying so. Idiopathic may therefore be regarded importance given to the patients etiological group may as an imprecise term given our increasing recognition and depend on the circumstance. For instance, a patient with discovery of the genes involved in many epilepsies, includ tuberous sclerosis has both a structural and a genetic etiol ing those with monogenic (with inherited or de novo patho ogy; the structural etiology is critical for epilepsy surgery, genic variants) or complex (polygenic with or without whereas the genetic etiology is key for genetic counseling environmental factors) inheritance. Such evidence is drawn from meticulous clin associated with epilepsy based on appropriately designed 9 ical research of the inheritance of these syndromes in twin studies. A structural etiology refers to abnormalities visible and family studies and does not mean that specific genetic on structural neuroimaging where the electroclinical assess mutations have been identified. Indeed, it is currently rarely ment together with the imaging findings lead to a reasonable the case that the genetic mutation(s) causing a patients epi inference that the imaging abnormality is the likely cause of lepsy has been determined, perhaps with the exception of the patients seizures. Structural etiologies may be acquired the infantile onset developmental and epileptic encephalo such as stroke, trauma, and infection, or genetic such as pathies, where many patients have been shown to have a de many malformations of cortical development. In individ frequent finding of mesial temporal lobe seizures with hip ual cases, the term Genetic Generalized Epilepsy may be pocampal sclerosis. Recogni critical information, as the finding of a mutation in a speci tion of these associations is important to ensure that the fic gene may not, on its own, enable prediction of the out patients imaging is carefully examined for a specific struc come. This in turn highlights the need for con considered in the context of the electroclinical presentation. Acquired structural causes include hypoxic-ischemic tribute to causation but are insufficient alone to cause 45,46 encephalopathy, trauma, infection, and stroke. In this setting, there may be no family history structural etiology has a well-defined genetic basis such as of seizures because other family members do not have tuberous sclerosis complex, which is caused by mutations in enough epilepsy genetic variants to be affected. This means that the patient has a new mutation that has Genetic etiology arisen in him or her, and therefore is unlikely to have a fam the concept of a genetic epilepsy is that it results directly ily history of seizures and has not inherited the genetic from a known or presumed genetic mutation in which sei mutation. Nevertheless, this patient may now have a herita zures are a core symptom of the disorder. For example if the individual has a de which a genetic etiology has been implicated are quite novo dominant mutation, their offspring will have a 50% diverse and, in most cases, the underlying genes are not yet risk of inheriting the mutation. A genetic etiology does not exclude an environmental Second, a genetic etiology may be suggested by clinical contribution. It is well accepted that environmental factors research in populations with the same syndrome such as contribute to seizure disorders; for example, many individu Childhood Absence Epilepsy or Juvenile Myoclonic Epi als with epilepsy are more likely to have seizures with sleep lepsy. Evidence for a genetic basis comes from elegant stud deprivation, stress, and illness. A genetic etiology refers to a ies such as Lennoxs twin studies in the 1950s and familial pathogenic variant (mutation) of significant effect in caus 41,42 aggregation studies. Third, a molecular basis may have been identified and may implicate a single gene or copy number variant of Infectious etiology major effect. There is an increasing number of patients with the most common etiology worldwide is where epilepsy 54 known genetic abnormalities causing both severe and mild occurs as a result of an infection. Molecular genetics has led to identification of tious etiology is that it directly results from a known infec the causative mutation in a large number of epilepsy genes, tion in which seizures are a core symptom of the disorder. An infectious etiology carries specific treatment Epilepsia, 58(4):512521, 2017 doi: 10. An infectious etiology may also refer to the difficulties to intellectual disability, to psychiatric features postinfectious development of epilepsy, such as viral such as autism spectrum disorders and depression, to psy encephalitis leading to seizures in the aftermath of the acute chosocial concerns. This area is expanding and a greater understanding of comorbidities be considered for every patient with epilepsy the phenotypic spectrum emerging. The concept of a meta at each stage of classification, enabling early identification, bolic epilepsy is that it results directly from a known or pre diagnosis, and appropriate management. Metabolic causes refer to a well delineated metabolic defect with manifestations or bio New Terminology and chemical changes throughout the body such as porphyria, Definitions uremia, aminoacidopathies, or pyridoxine-dependent sei Developmental and epileptic encephalopathies zures. In many cases, metabolic disorders will have a the term epileptic encephalopathy was redefined in the genetic defect. The identification of specific meta above and beyond what might be expected from the under bolic causes of epilepsy is extremely important due to lying pathology alone. Global implications for specific therapies and potential prevention or selective impairments can worsen over time. Immune etiology the concept of the epileptic encephalopathy may be the concept of an immune epilepsy is that it results applicable to epilepsies at all ages and should be utilized directly from an immune disorder in which seizures are a more widely than just for the severe epilepsies with onset in core symptom of the disorder. Many epilepsy syndromes associ has been recently recognized with characteristic presenta 54 ated with encephalopathy have a genetic etiology, such as tions in both adults and children. An immune etiology can West syndrome, where there is marked genetic heterogene be conceptualized as where there is evidence of autoim ity, and Epileptic encephalopathy with continuous spike mune-mediated central nervous system inflammation. Equally, such syndromes may have an increasing, particularly with greater access to antibody test acquired cause such as hypoxic-ischemic encephalopathy or ing. With the development that may also have a genetic or acquired etiol emergence of these entities, this etiologic subgroup ogy. However, a Unknown means that the cause of the epilepsy is not yet single gene may cause an epileptic encephalopathy in some known. There remain many patients with epilepsy for whom individuals and a self-limited epilepsy in others; examples the cause is not known. In an epileptic encephalopathy, the abundant epilep cal semiology such as frontal lobe epilepsy. The extent to tiform activity interferes with development resulting in cog which a cause can be found depends on the extent of the nitive slowing and often regression, and sometimes is evaluation available to the patient. This differs across differ associated with psychiatric and behavioral consequences. A key component of the concept is that amelioration of There is increasing awareness that many of the epilepsies the epileptiform activity may have the potential to improve are associated with comorbidities such as learning, psycho the developmental consequences of the disorder. These range in type and severity, from subtle learning rored in the observations of families and clinicians. There may be preexisting develop nized developmental and epileptic encephalopathies can mental delay, complicated by plateauing or regression with now be called by their gene name together with the word seizure onset or with prolonged seizures. Then the term of Dravet syndrome, in which developmental slowing or encephalopathy can be used to denote the severe form of regression occurs between 1 and 2 years of age, at a time the disease associated with developmental impairment.

Recommended Pump Discharge Pressures for Standpipe Operations Recommended Fire Floor Pump Discharge Pressure 1 10 150 psi 11 20 200 psi 21 30 250 psi 31 40 300 psi 41 50 350 psi 51 60 400 psi 61 70 450 psi 71 80 500 psi 81 90 550 psi 91 100 600 psi 101 110 650 psi Variations in building and standpipe system layout menstruation rituals around the world buy generic danazol on-line, length of supply lines womens health big book of yoga discount danazol 100 mg fast delivery, etc womens health 092012 buy danazol us. These separate risers are not interconnected pregnancy week 6 discount danazol 50mg visa, so supplying the High Zone riser will not charge the Low Zone riser and vice versa. The connections shall be identified with signage stating either Low Zone or High Zone and indicate the floors they serve. The High Zone riser is also known as Express Piping since it bypasses lower floors. Each engine company shall carry a "standpipe kit" with the following minimum basic complement of tools: 2 " controlling nozzle with 1 " main stream tip and 1 " x 2 " increaser. For example, some buildings may contain floor outlet valves with non-New York City threads. In most instances, three lengths will be brought into the building by each engine company. The third and fourth engines shall operate similarly when operating the second hoseline. Rubber balls and soda cans lodged within a standpipe riser or piping can restrict water flow to the controlling nozzle. The first arriving control firefighter should remain in close proximity to the standpipe outlet throughout the operation in case Fig. The in-line pressure gauge should always be used to ensure correct nozzle pressure and a good fire stream (see Fig. Ensure the hoseline is charged and bled by opening the nozzle fully, and checking for an adequate firefighting stream before entering the fire area. Sometimes this may require charging and bleeding the line in the stairway, such as when an apartment door is left open and high heat conditions exist in the hallway, or at commercial building fires with large, open floor areas. Other times, a dry hoseline can be stretched to the apartment door and charged and bled in the public hallway. Once operating, if the nozzle is shut down the reading on the in-line pressure gauge will increase due to the back pressure and should not be adjusted at this time. Once the nozzle is re-opened to extinguish the fire, the reading on the in-line pressure gauge should return to the set pressure. It is important to continuously monitor the in-line pressure gauge closely once the attack is started and adjust the valve wheel as necessary to maintain the proper pressure. The control firefighter should be aware that kinks, cracking or shutting down the nozzle, etc. Most automatic sprinkler system failures can be traced to human error, sabotage, vandalism, or explosions which knock out sprinkler system piping. It is essential that all firefighters have a sound, working knowledge of automatic sprinkler systems and the specific tasks required of the engine company to support them. Increasingly, sprinkler systems are being installed in residential occupancies-both permanent (multiple dwellings) and transient (hotels and motels). Water supplies for automatic sprinkler systems include city main and usually one other source-gravity tank, pressure tank, cistern or suction tank. As soon as a sprinkler head activates due to the heat of a fire, water is immediately discharged through the open head. The air (or nitrogen) is under pressure and this pressure maintains a "differential dry pipe valve" in the closed position. When a sprinkler head activates, the air (or nitrogen) is exhausted through the open head, thus allowing the differential dry pipe valve to open and water to be admitted to the riser and piping. In a deluge system, all sprinkler heads (or nozzles) are open and will flow water simultaneously. Pre-action systems are most often found in computer rooms or where other sensitive electronic equipment is used. The idea is that once a fire is detected, the valve opens admitting water to the piping. If manual fire control efforts are unsuccessful, the sprinkler system actuates and will quickly control the fire. By maintaining the piping dry during normal operations, the danger of a large water damage loss due to a break in the piping or accidental damage to a sprinkler head, is avoided. Non-automatic sprinkler systems depend solely upon the fire department to supply water for firefighting. These systems may contain fusible sprinkler heads, open sprinkler heads, or even perforated pipes. For reference, the other colors used and what they indicate are as follows: Green Automatic Sprinkler System Red Standpipe System Aluminum Non-automatic Sprinkler or Perforated Pipe Yellow Combination Sprinkler/Standpipe If no color coding is present, each siamese connection should be identifiable as to the type of system it supplies. This information is usually embossed or stamped on a plate or the siamese connection itself. If the first due engine is supplying both the standpipe and sprinkler systems, the second and third due engine companies must stretch additional lines to augment both systems. Every effort must be made to augment the system with additional supply lines from other first alarm engine companies. These difficulties include missing caps, defective threads, debris stuffed into the connection, tight caps, frozen female swivels, and clappers either broken or jammed open. In addition to broken glass and sharp metal edges, junkies have been known to store or discard hypodermic needles inside siamese connections. A spare 3-inch male cap should be carried by all engine companies in the event it becomes necessary to cap one side of the siamese connection to prevent an outflow of water due to a malfunctioning clapper valve. Immediately stretching and connecting a second 3 1/2-inch line is another potential remedy for this problem. These caps are usually attached with screw eyes placed over the pin lugs on the female swivel (see page 6, Fig. Both metal and plastic caps are best removed by striking the center of the cap with a tool. The engine company officer should order the sprinkler system augmented/supplied upon indication of a working fire (smoke, heat, visible fire, reports from employees or security guards) or based on reconnaissance information from ladder company personnel indicating same. Water flow alarms indicate only that water is flowing, but it may be due to reasons other than a fire- such as broken piping or a dislodged sprinkler head. This pressure will have to be adjusted accordingly based on reports of sprinkler system performance received from ladder company personnel, if more than two lengths of 3 1/2-inch hose are needed to reach the siamese connection and for fires on upper floors. The Digital In-Line Gauge does not regulate water flow, but provides members with the ability to monitor the pressure and flow being delivered from the standpipe outlet to the nozzle team. Static pressure (control valve open, nozzle closed, no movement of water) is not an indicator of sufficient nozzle pressure. Suspect kinks if the pressure reading is normal or higher and the flow is reduced below normal. Suspect a burst length if the pressure reading is normal or lower and the flow is increased above normal. Note: If the Digital In-Line Gauge fails to display upon initial start-up, make another attempt to turn the gauge on. If this attempt fails, the control firefighter shall verify with their officer that the nozzle team is receiving proper pressure and flow. Since the Digital In-Line Gauge does not regulate water flow, hoseline operations can continue without the display functioning properly. The officer must monitor water pressure and flow and communicate the need for any adjustments to the Control Firefighter. The visual alerts are set at the following levels and will give the Control Firefighter an early indication of a condition that may require attention. The resumption of water flow during this sleep mode will re-activate the digital display automatically. Storing only one spare battery in carry case will prevent damage to batteries due to battery terminal cross-contact. Condition of the battery installed in the gauge is to be checked each tour using this Battery Test Function. Ensure that the battery terminals are properly aligned and do not force the connection. Remove the batteries from the Digital In-Line Gauge and the carry case (clear pouch).

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Case Management Case Management assists Members to menstruation occurs when there is a decrease in discount 100mg danazol otc optimize the use of their benefits and available community resources to menopause guidelines order danazol 200 mg free shipping gain access to breast cancer earrings discount danazol 200mg online quality health care in all settings womens health 7 flat belly proven danazol 100mg. The Case Management programs help coordinate services for Members with health care needs due to serious, complex, and/or chronic health conditions. The programs coordinate benefits and educate Members who agree to take part in the Case Management program to help meet their health-related needs. Case Management programs are confidential and voluntary and are made available at no extra cost. These programs are provided by, or on behalf of and at the request of, health plan case management staff. If the Member meets program criteria and agrees to take part, we will help the Member meet identified health care needs. This is reached through contact and team work with the Member and/or the Members chosen authorized representative, treating Physician(s), and other providers. In addition, assistance may be provided in coordinating care with existing community-based programs and services. This may include giving information about external agencies and community-based programs and services. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization. OptiNet Registration the OptiNet Registration is an important tool that assists ordering providers in real-time decision support information to enable ordering providers to choose a high quality, low cost imaging providers for their patients. The score for the Facility will be presented to the ordering Provider when the particular Facility is selected as a place of service which drives Ordering Provider Decision Support. The Medical Management Department will conduct a medical review based on medical necessity criteria only from the date that notification of the hospital admission is received, if the patient is still in the hospital, or for outpatient services, the date notification of services is received. If the patient has already been discharged or outpatient services terminated at the time of the notification, Medical Management will not review the services or admission and the claim will be denied. Failure to obtain precertification for services will result in a denial of payment to the provider. If the member fails to notify Medical Management for a service requiring precertification, the service will either: a. Be denied if upon retrospective review, the service is determined to be not medically necessary or investigational. The covered member will be subject to a monetary penalty specific to his or her health benefit plan if the covered service is medically necessary. If we subsequently deny a claim for lack of medical necessity upon retrospective review and a waiver has not been signed by the covered member, you will have the right to appeal. We encourage you to contact us on behalf of the member to precertify services where required. For more information please see the Utilization Management section in this Provider Manual. Emergency Services Emergency services are not subject to prior approval, but the provider must notify the plan of the service according to notification requirements. Emergency service shall mean those covered services provided in connection with an emergency condition. Emergency condition means a medical or behavioral condition, the onset which is sudden, that manifests itself with symptoms of sufficient severity, including severe pain that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention could result in: 1. To the extent the member is admitted, we require notification of all inpatient emergency admissions within forty eight hours of the admission. To comply with this requirement, call Empires Medical Management Program at 1-800-982-8089. You may notify us of an emergency admission by submitting the information through Empires Online Services. If you are not yet registered to use this service, please go to Empires website, empireblue. Doing so will provide a fast and dependable way to notify Empire of admissions without having to make a telephone call Empires Facility Online Services is available 24/7, with the exception of brief periods when the website undergoes system maintenance. Continued Stay Decision and notification to enrollee and provider by phone and in writing within one (1) business day of receipt of all necessary clinical information or 72 hours, whichever is shorter. Home Care Request Decision and notification to enrollee and provider by phone and in writing within Following Inpatient one (1) business day of receipt of all necessary information. If the day after the Admission request for services falls on a weekend or holiday, within seventy two (72) hours of receipt of necessaryinformation. Post-Service Decision and written notification to enrollee and provider within thirty (30) calendar days of receipt of all necessary clinical information. If you would like more information regarding our Medical Management Program, visit empireblue. Continued Stay Review Process Telephonic Once we have approved an initial length of stay or outpatient service/treatment, the facility or provider will continue to work with the Empire Medical Management Department for approval of additional days or services. It is the provider or facilitys responsibility to provide all necessary clinical information to Empires Medical Management Department. When a member has required an inpatient stay, the goal of our Medical Management Department is to support a treatment plan that provides optimum care in a cost-effective manner that result in the earliest possible successful discharge consistent with the patients medical needs and reduces the likelihood of a readmission. For members requiring outpatient services, the goal of our Medical Management Department is to support a treatment plan that providers the appropriate number of treatments in the most appropriate setting, resulting in the successful conclusion of services consistent with the patients medical needs. Licensed Nurses may contact you or your utilization review staff to gather clinical information to assess medical necessity for the member. The nurses utilize clinical information from the medical record, the hospital staff, and/or attending physician in conjunction with medical necessity criteria,, medical policies and clinical guidelines to coordinate a medically effective and efficient transition through the case management process. If the clinical information provided does not meet the medical necessity criteria for approval of the requested service or treatment, the nurse reviewer will refer the case to a Medical Director (licensed physician) for his/her review. A Medical Director will review the information provided and may discuss the case with the attending physician. If a determination is made that treatment or inpatient stay is not medically necessary, the attending physician, the facility and the patient or patient representative will be notified immediately of the decision not to certify. This report will not list members who are managed by third-party utilization vendors. The facility will need to contact the specific third-party utilization management vendor directly. The reports format allows easy identification of patients status in relation to our Medical Management decisions from the previous day, current day, and the next review date. The report will reflect information received in our Medical Management System by end of business of the previous day. The column marked Next Review Date will identify those patients for whom additional clinical information is required to continue authorization for the hospital stay. This information must be communicated to our Medical Management Department via fax or phone before 3 p. During non-business hours you will have an option to leave a voicemail message or reach a nurse on weekend or holiday business hours. If any of the information contained in the report is perceived to be incorrect, the facility shall contact our nurse reviewer staff at the toll-free number indicated in the column specific to that patient on the report. The hospital shall use good faith efforts to contact the admitting physician to obtain a discharge order when appropriate and Empire shall reasonably cooperate with such efforts. In addition, Empire will provide a separate written notice of determination, consistent with applicable legal requirements. Delay in Service Denials If an Empire covered member has his or her inpatient hospital stay extended as a result of an unwarranted delay in the provision of hospital services due to the unavailability of any hospital equipment, personnel, facilities or test results we will not reimburse the facility or provider for the additional bed day(s). Some examples of service delays are equipment failure, operating room scheduling backlog, and unavailable test results. Coverage denials based on the fact that there was, in our judgment, an unnecessary delay in providing a service do not involve a medical necessity determination. They are, therefore, not subject to appeal under our Medical Management Reconsideration and Appeals Process. The member must be held 121 | Page harmless and the facility or the physician may file a grievance under our grievance procedure. Medical Necessity Denials A written notice of an initial adverse determination (denial of coverage) will be sent to an Empire covered member and provider and includes: 1. Instructions on how to initiate internal appeals (standard and expedited appeals) and eligibility for external appeals; 3.

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In the operating room women's health clinic coffs harbour cheap danazol uk, acute ment of excessive bleeding88%; and monitoring and lab intravascular hemolytic transfusion reactions secondary to women's health weight loss running purchase 50mg danazol fast delivery oratory testing for transfusion reactions88% menstruation after mirena removal discount 200mg danazol amex. The symptoms (fever menopause high blood pressure order generic danazol, hypoxemia, acute Dong Quoi respiratory distress, increased peak airway pressure) occur Feverfew within 6h after the transfusion. Except for the presence of Fish oil fever, these symptoms are undistinguishable from those of Flax seed oil transfusion-associated circulatory overload. Treatment consists Garlic of stopping the transfusion and instituting critical care sup Ginger portive measures. Ginko biloba Bacterial contamination of blood components is most often Grape seed extract associated with platelet transfusion as platelets are stored a Saw palmetto 2024C which facilitates the growth of bacteria. Tere has been a signifcant decrease in fatalities associated with bacte Herbs that Inhibit Clotting rial contamination since 2001, as processes to detect bac Chamomile terial contamination in platelets have been put into place. Dandelion root Bacterial contamination is manifested by hyperthermia and Anesthesiology 2015; 122:241-75 15 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Occasionally, allergic reactions are more starting antibiotics, and supportive measures. Allergic reactions are caused by immunoglobulin E anti Citrate is the anticoagulant used to collect blood com bodies in the patient against proteins in the plasma of ponents and it is present in signifcant amounts in all blood the blood component transfused. Symptoms usually are restricted whelmed and the patient develops citrate toxicity (hypocal to urticaria and other erythematous skin manifestations cemia and hypomagnesemia) which may result in adverse and subside spontaneously or with diphenhydramine cardiac manifestations. Anesthesiology 2015; 122:241-75 16 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. The decision to apply some or all the criteria shown in this table is dependent upon the clinical context and judgment of the practitioner. Scientifc evidence is insuffcient to evaluate the perioperative beneft of applying the above suggested criteria. Anesthesiology 2015; 122:241-75 17 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Practice Guidelines Anesthesiology 2015; 122:241-75 18 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Practice Guidelines Anesthesiology 2015; 122:241-75 20 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Practice Guidelines Anesthesiology 2015; 122:241-75 22 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Practice Guidelines Anesthesiology 2015; 122:241-75 24 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Practice Guidelines Acknowledgments Supported by the American Society of Anesthesiologists and developed under the direction of Jeffrey L. Correspondence Address correspondence to the American Society of Anes thesiologists: 1061 American Lane, Schaumburg, Illinois 60173. Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report by the American Society of Anesthesiologists Task Force on blood transfusion and adjuvant therapies. Benoist s, Panis y, Pannegeon V, Alves A, Valleur P: Predictive factors for perioperative blood transfusions in rectal resec tion for cancer: A multivariate analysis of a group of 212 patients. Bjessmo s, ivert t: Blood loss after coronary artery bypass surgery: Relations to patient variables and antithrombotic treatment. Neurosurgery 2001; 49:106874 patients with glucose-6-phosphate dehydrogenase def 30. Lancet 2011; 378:1396407 analysis of transfusion requirements and the effects of auto 31. Pirat A, sargin D, torgay A, Arslan G: identifcation of pre transfusion of cell saver blood in 164 consecutive patients. Katz K, tamary h, Lahav J, soudry M, Cohen iJ: increased Proc 2002; 34:21535 operative bleeding during orthopaedic surgery in patients 32. Bull Coagulation tests during cardiopulmonary bypass correlate hosp Jt Dis 1999; 58:18890 with blood loss in children undergoing cardiac surgery. Acta Anaesthesiol topol eJ: Revisiting optimal anticoagulation with unfrac scand 1996; 40:6414 tionated heparin during coronary stent implantation. Lison s, spannagl M, Dietrich W; Working Group of Cardiol 2003; 92:146871 Perioperative hemostasis: hemophilia A in cardiac opera 34. J Formos Med Assoc 1998; 97:2835 value of blood clotting tests in cardiac surgical patients. Walsh ts, Palmer J, Watson D, Biggin K, seretny M, Davidson on postoperative blood loss in complex cardiac surgery: A pro h, harkness M, hay A: Multicentre cohort study of red blood spective observational study. Anesth Analg 2010; 110:153340 cell use for revision hip arthroplasty and factors associated 41. Murray D, Pennell B, olson J: Variability of prothrombin time with greater risk of allogeneic blood transfusion. Br J Anaesth and activated partial thromboplastin time in the diagnosis of 2012; 108:6371 increased surgical bleeding. J Cardiothorac Vasc Anesth 1995; 9:35561 differs in anemic and nonanemic patients. Kulier A, Levin J, Moser R, Rumpold-seitlinger G, tudor iC, standard laboratory tests in patients after cardiac surgery. A guide for programme impact of preoperative anemia on outcome in patients managers. World health organization 2001 Anesthesiology 2015; 122:241-75 27 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Walpoth B, Galliker B, spirig P, haeberli A, Rosenmund A, and response to epoetin alfa in orthopedic surgery patients. The transfusion requirements in patients undergoing elective car American erythropoietin study Group. Weisbach V, skoda P, Rippel R, Lauer G, Glaser A, Zingsem Whitsitt P, Wheeler sL, Lau Cy: erythropoietin with iron sup J, Zimmermann R, eckstein R: oral or intravenous iron as an plementation to prevent allogeneic blood transfusion in total adjuvant to autologous blood donation in elective surgery: A hip joint arthroplasty. J Urol 2002; 168:6103 jected to aggressive removal of blood for autologous use: 67. A prospective randomised takaku F, yamamura h: subcutaneous administration of controlled study. A prospective randomised multicentre trial of the infuence of recombinant human controlled study. Br J surg 1998; 85:6367 erative blood loss and blood transfusion requirements in 55. J thorac Cardiovasc surg 2007; 134:5964 poietin administration in patients with gastrointestinal tract 70. Acta Paniagua P, Berwanger o, srinathan s, Graham M, Pasin L, haematol 1998; 100:6976 Le Manach y, Gao P, Pogue J, Whitlock R, Lamy A, Kearon C, 57. N engl J Med 2014; 370:1494503 gous blood donation in patients with low hematocrits: A 71. Pettersson e, Darvish B, Krook h, swahn e, eintrei C: to transfusion 1996; 36:2936 continue or discontinue aspirin in the perioperative period: 58. Br J Anaesth 2010; erythropoietin and hemoglobin concentration at opera 104:30512 tion and during the postoperative period: Reduced need 72. J Zhejiang Univ sci spine (Phila Pa 1976) 2002; 27:206771 B 2007; 8:5605 Anesthesiology 2015; 122:241-75 28 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Kajikawa M, Nonami t, Kurokawa t, hashimoto s, harada A, dial ischaemia and haemoglobin concentration: A random Nakao A, takagi h: Autologous blood transfusion for hepa ized controlled trial of transfusion strategy in lower limb tectomy in patients with cirrhosis and hepatocellular carci arthroplasty. Acta Anaesthesiol scand 2001; 45:2006 Auler Jo Jr: transfusion requirements after cardiac sur 79. J Cardiothorac surg 2012; 7:95 Lowering the hemoglobin threshold for transfusion in coro 100. Blackbourne Lh: impact of policy change on Us Army com transfusion 1999; 39:10707 bat transfusion practices. Dexter F, Ledolter J, Davis e, Witkowski tA, herman Jh, trial limiting perioperative red blood cell transfusions in vas epstein Rh: systematic criteria for type and screen based cular patients. Karger R, Bornmann A, Kretschmer V: Limited utility of strategies after elective operations for myocardial revascular algorithms predicting blood transfusions. Arch orthop trauma surg 2011; 131:6637 Anesthesiology 2015; 122:241-75 29 Practice Guidelines Copyright 2014, the American Society of Anesthesiologists, Inc. Menichetti A, tritapepe L, Ruvolo G, speziale G, Cogliati A, unnecessary cross-matching: A patient-specifc blood Di Giovanni C, Pacilli M, Criniti A: Changes in coagulation ordering system is more accurate in predicting who will patterns, blood loss and blood use after cardiopulmonary receive a blood transfusion than the maximum blood bypass: Aprotinin vs tranexamic acid vs epsilon aminoca ordering system. J reducing blood loss after primary total hip arthroplastya emerg trauma shock 2012; 5:3217 prospective randomized double-blind placebo-controlled study.

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