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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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"EMTALA: The Essential Guide to Compliance" from Thomson American Health Consultants, publisher of Emergency Medicine Reports, explains how the changes to EMTALA will affect emergency departments and off-campus clinics.
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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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Advancing technology continues to reshape the way care management is practiced in the ICU and elsewhere, but early experience shows that technology is no guarantee for physician buy-in at the front end, much less patient compliance at the back end.
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Good ED/ICU networks are becoming more important as more rural hospitals close due to lack of funding, says Janet Williams, MD, FACEP, director of the Center for Rural Emergency Medicine and Professor of Emergency Medicine at West Virginia University in Morgantown.
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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.
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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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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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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.