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Recent cases involving the undertreatment of pain, the over-treatment of pain (and thereby the creation of addicts), and whether drug seekers have any legal rights to pain management have created management problems for the emergency physician. This issue of ED Legal Letter will look at some of these cases. The author addresses recent changes in pain management medications, and readers will be able to develop a practical approach to the patient with pain with fewer worries about the legal consequences.
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The emergency physician plays a key role in the management of HIV. Emergency physicians encounter all phases of the illness, from counseling patients on safe sex practices to treating the medical complications of chronic immunosuppression. Despite all of the recent advances, HIV infection and AIDS remain challenging and continually evolving diseases. In this issue of Emergency Medicine Specialty Reports, the authors provide a comprehensive update on the diagnosis and clinical management of HIV infection and its complications.
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Although pediatric cardiac diseases infrequently are seen in the emergency department (ED), early diagnosis and aggressive management is critical. Most importantly, the clinician must include these diseases in their differential and have a thorough understanding of typical and atypical presentations for congenital heart disease, dysrhythmias, myocarditis and pericarditis. Any child who has a clinical presentation suggestive of cardiac disease, must receive appropriate diagnostic testing and timely referral to optimize the childs outcome. The authors provide a thorough, focused review of the most commonly encountered cardiac diseases in the ED and key aspects to stabilization.
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Although an increasingly uncommon scenario, pediatric patients continue to suffer fatal consequences of poisonings in the United States each year. Individuals providing care for the pediatric population continue in their efforts not only to find ways to treat exposed children, but also to avoid exposures from occurring at all. The goal of reducing morbidity and mortality from poisonings in ever-changing environments, both in the home and at the hospital, remains a challenge to all caregivers.
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Patients who received hyperoxia during general surgery had an increase in surgical site infections compared to those who received a lower oxygen concentration.
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The gold standard in the era of EBM is the randomized controlled trial (RCT). A properly designed and carried out RCT, in patients similar to those the practitioner manages and using end points relevant to both practitioner and patient, is more likely to be free from bias and to produce results that will stand up over time than other types of investigation such as retrospective analyses, case-control studies, and unsystematic clinical observations.
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In this randomized, controlled trial, when patients developed recurrent respiratory failure following extubation, the use of noninvasive ventilation delayed but did not prevent reintubation, and this delay was associated with a higher mortality rate in the ICU.
