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This review will provide a guide to ventilator management to aid the ED physician. Pulmonary physiology and adverse effects of artificial ventilation on the pulmonary system will be discussed. Assist control ventilation is the most common mode of ventilation and should be used initially for patients in the ED. Pitfalls of therapy and troubleshooting the ventilator will be reviewed, recognizing that the respiratory therapist is a valuable reference and capable of handling the majority of mechanical ventilation issues. Finally, difficult cases will arise requiring early consultation with a critical care specialist to provide optimal ventilation while avoiding complications.
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This issue covers Part I of a two-part series on evaluation and management of sexual assault in the emergency department. Part I of the series discusses initial ED care, physical exam, and evidence collection. Part II will cover laboratory analysis, pharmacotherapy, disposition, follow-up, documentation, and court testimony.
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Pertussis, or whooping cough, was first described in the 16th century, and the causative agent was isolated in 1906. Nonetheless, pertussis remained a major cause of morbidity and mortality among ch ildren well into the 20th century.
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Bacterial resistance to antibiotic treatment has concerned the medical community since the introduction of the first antibiotics in the 1920s. Development of new anti-infective agents has been precipitated by increasing resistance to older agents and classes of agents.
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Ultrasound utilizes frequencies well above the range of human hearing to penetrate and visualize structures in the body. While human hearing is generally in the range of 20-20,000 Hz (cycles/second), diagnostic ultrasound is typically in the range of 2-12 mega-hertz (MHz), or 2-12 million cycles per second.
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While children typically have a lower severity of illness than their adult counterparts during visits to the emergency department (ED), they also present with some of the most serious illnesses. Furthermore, there are a wide range of possible illnesses with potentially devastating outcomes for children. Unfortunately, the relative rarity of critically ill or injured children means that clinical experience potentially may be lacking or even atrophied over time.
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Difficult airway is a broad term that unfortunately encompasses many clinical situations and their potential management options. Airway management difficulties can be divided into those that are predicted and those that are unexpected. They also can require immediate attention (emergent) or be stable (non-emergent). Difficulty can arise at any stage of airway management. Development of a standardized airway assessment and approach to management allows the physician to provide better patient care. Optimal care requires skill in assessing the situation, knowledge of equipment, and finally, how to use it successfully.
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Once the diagnosis of alcohol withdrawal syndrome is confirmed, the treatment of the life-threatening sequelae must be swift. For many years, the pharmacologic agent of choice to treat AWS has been quite controversial. Benzodiazepines, antiepileptic agents, ethanol, and barbiturates have all been the preferred drug at one time or another. In recent years, benzodiazepines have come to the forefront as the drug class of choice, although some agents may offer advantages over others. Several guidelines have been developed to aid the emergency medicine practitioner select the most effective and efficient therapy. This review outlines, in systematic detail, the full range of AWS and risk-directed interventions shown to improve clinical outcomes in AWS.
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