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The emergency physician is faced with a wide variety of acute respiratory emergencies in daily practice. Noninvasive ventilation (NIV), a means of delivering positive pressure ventilation without the use of an endotracheal tube, is a powerful therapeutic tool in the hands of an informed physician. This article will delineate the physiology of NIV. It will provide guidelines for initiation, weaning, and possible complications of NIV. It also will highlight current research in the topic.
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Emergency department physicians must be vigilant to accurately assess,
rapidly stabilize, and appropriately transport a severely injured
patient to the level of trauma care the patient requires. Instead of
viewing missed injuries as occurrences that result from inexperience or
incompetence, strategies to minimize the occurrence of missed injuries
and the resulting consequences are needed. All aspects of a trauma
system must work together to improve patient care.
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Although cervical spine injuries are uncommon in children, a missed or
delayed diagnosis may have devastating consequences for the patient. A
thorough understanding of normal pediatric anatomy, injury patterns,
and children who are at increased risk for injury is critical for the
physician caring for the acutely injured child.
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The FDA has approved the first nasally administered flu vaccine to be marketed in this country. Medimmunes FluMist is also the first influenza vaccine to use live virus.
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Although noninvasive positive-pressure ventilation (NPPV) has become a standard of care for acute-on-chronic ventilatory failure in patients with chronic obstructive pulmonary disease (COPD), the numerous reported studies have left uncertain how the clinician should select patients who should receive this therapy.
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A time lapse of > 4 hours in ICU transfer after the development of 1 or more physiologic threshold criteria was associated with greater mortality, longer hospital length of stay, and higher costs.
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Patients who were transferred directly to the authors medical ICU from other hospitals were sicker and had worse outcomes than those who were directly admitted. Benchmarking data generated without taking referral source into account erroneously indicated an excessive death rate and other adverse outcomes.
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The randomized, controlled trial (RCT) is believed to provide the strongest evidence for verifying both effectiveness and ineffectiveness of a given treatment. Once the RCT judges the proposed treatment as ineffective, it is rare that the treatment is ever evaluated again.
