Emergency
RSSArticles
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Do We Really Know the Optimal Oxygen Target in Patients with ARDS?
In the LOCO2 study, a conservative oxygen strategy with SpO2 goals of 88% to 92% was not shown to improve mortality over a liberal oxygen strategy as hypothesized, but rather was found to have a worrisome signal of increased mortality and increased mesenteric ischemia.
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Management of Pulmonary-Renal Syndrome
The role of the intensivist in the management of pulmonary-renal syndrome includes appropriate respiratory support and recognition and management of concurrent infection, hypovolemia, acute anemia, and coagulopathy.
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New Approaches for Ethically Challenging ED Cases
For emergency providers, time is precious. If a full-blown consult is not possible, ethicists can help discern the most critical aspect of a concern these clinicians may express. Quick, in-person responses; phone consults; and telemedicine consults all are possible approaches.
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End-of-Life Care Should Not Vary Depending on Provider
Clinicians must be careful about imposing medical staff priorities over patients’ priorities. Making presumptions is dangerous. Ethicists can help by explaining the provider’s responsibility to offer accurate information.
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Physicians Reported Moral Distress About Surrogate Decision-Makers
Parties clash regarding comfort levels and how aggressive treatment should be. The lack of advance directives for so many patients exacerbates the problem. Nurses and other colleagues can join the conversations to assist or outright substitute for physicians who are unwilling or unable to engage deeply.
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Communicate Collaboratively Before End-of-Life Care Conversations Disintegrate
Once communication breaks down, it is difficult to rebuild. Clinicians, ethicists, and palliative care all should be talking to each other to be sure the family hears a common message.
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Families Are Confused, Skeptical About ‘Inappropriate’ Treatment
Many, if not most, ethics consults involve conflicts over withdrawal of life-sustaining treatment at the end of a patient’s life. Yet families are likely to be quite confused by commonly used terms such as “futile” and “potentially inappropriate.”
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Veterans with PTSD, TBI at Much Higher Risk for Heart Attack
Such patients also more likely to experience first attack at a younger age than the general population.
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Fever in the Returning Pediatric Traveler
Although, currently, there are travel restrictions in many countries, this will pass. Acute care physicians need to have an awareness of diseases that are prevalent in other countries to accurately diagnose, manage, and treat patients traveling to and from other parts of the world. The authors present an incredibly valuable synopsis of fever and differential of fever in returning pediatric travelers
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Length of Time in ED Linked to Patient Safety Events
The odds of a patient safety event (defined as a near-miss event or adverse event) increase by 4.5% for every additional hour a patient stays in the ED, according to the authors of a recent study.