Internal and emergency medicine
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Pneumonia is an important cause of mortality in intensive care units. The incidence of pneumonia in such patients ranges between 7 and 40%, and the crude mortality from ventilator associated pneumonia may exceed 50%. Although not all deaths in patients with this form of pneumonia are directly attributable to pneumonia, it has been shown to contribute to mortality in intensive care units independently of other factors that are also strongly associated with such deaths. ⋯ A combination of topical and systemic prophylactic antibiotics reduces respiratory tract infections and overall mortality in adult patients receiving intensive care. A treatment based on the use of topical prophylaxis alone reduces respiratory infections, but not mortality. The risk of occurrence of resistance as a negative consequence of antibiotic use was appropriately explored only in the most recent trial by de Jonge, which did not show any such effect.
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Airway management is unequivocally the most important responsibility of the emergency physician. No matter how prepared for the task, no matter what technologies are utilized, there will be cases that are difficult. ⋯ When the patient is encountered, it is too late to check whether appropriate equipment is available, whether a rescue plan has been in place, and what alternative strategies are available for an immediate response. The following article will review the principles of airway management with an emphasis upon preparation, strategies for preventing or avoiding difficulties, and recommended technical details that hopefully will encourage the reader to be more prepared and technically skillful in practice.
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With the arrival of point-of-care cardiac marker determination, emergency physicians may be able to arrive at the diagnosis of cardiac ischemia faster than ever before. However, these tests must be used with care, as a lack of understanding about when and how they should be obtained is important both for good patient care and to avoid medicolegal pitfalls. This report reviews risk stratification of patients who present with chest pain, provides an overview of cardiac markers and literature supporting their use, and concludes with a practice guideline for the utilization of cardiac markers in the emergency department.