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Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule).
Choosing Wisely Canada
Canadian Association of Emergency Physicians
Head injuries in children and adults are common presentations to the emergency department. Minor head injury is characterized by: Glasgow Coma Scale (GCS) 13-15, associated with either witnessed loss of consciousness, definite amnesia, or witnessed disorientation. Most adults and children with minor head injuries do not suffer from serious brain injuries that require hospitalization or surgery. CT head scans performed on patients without signs of significant injuries can expose patients to ...
ver más ... 2018Don’t routinely transfuse red blood cells in hemodynamically stable ICU patients with a hemoglobin concentration greater than 70 g/l (a threshold of 80 g/L may be considered for patients undergoing ...
Choosing Wisely Canada
Canadian Critical Care Society
Unnecessary transfusion of red blood cells (RBCs) is more harmful than helpful, and wastes a limited resource, which should be reserved for patients with proven indications. Transfusing RBCs at a threshold higher than 70 g/L does not improve survival in ICU patients, and is associated with more complications and higher costs. This has been extensively studied and a restrictive transfusion strategy results in similar or lower mortality compared with higher thresholds, and other complications, ...
ver más ... 2018Don’t order routine chest radiographs for critically ill patients, except to answer a specific clinical question.
Choosing Wisely Canada
Canadian Critical Care Society
Chest radiographs (“X-rays”, CXRs) are not indicated for routine assessment of critically-ill patients except when indicated for specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, pulmonary artery catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in patient’s clinical condition, and if the information will likely impact a specific decision related to ...
ver más ... 2018Don’t continue mechanical ventilation without a daily assessment for the patient’s ability to breathe spontaneously.
Choosing Wisely Canada
Canadian Critical Care Society
Screening for readiness for liberation from mechanical ventilation with spontaneous breathing trials allows clinicians earlier recognition of patients that may be liberated from mechanical ventilation.
ver más ... 2018Don’t prolong mechanical ventilation by over-use of sedatives and bed rest.
Choosing Wisely Canada
Canadian Critical Care Society
Maintaining critically ill patients in an immobile or minimally mobile state during care may potentiate muscle loss and deconditioning. Excessive and/or prolonged use of sedatives is associated with worse outcomes, including increased delirium, excessive use of diagnostic imaging for coma, increased number of tracheostomies, greater duration of mechanical ventilation and ICU length-of-stay.
ver más ... 2018