Chest
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Physicians may encounter medical emergencies outside a hospital or clinical setting, such as on an airplane or at a sporting event. Physicians, particularly critical care physicians, should feel a call of duty to assist in a medical emergency and may do so without complete knowledge of existing laws for protection. The intent of this article is to encourage physicians to have a detailed awareness of Good Samaritan laws in the United States. ⋯ All states except Kentucky have statutory language providing immunity to physicians licensed in any other state as well. Some states have interesting statutes relative to other aspects of medical emergency care. A physician entrusted to practice medicine by society and law should be willing to provide appropriate medical care wherever needed.
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Multicenter Study
Flash mob research: a single-day, multicenter, resident-directed study of respiratory rate.
Vital signs are critical data in the care of hospitalized patients, but the accuracy with which respiratory rates are recorded in this population remains uncertain. We used a novel flash mob research approach to evaluate the accuracy of recorded respiratory rates in inpatients. ⋯ Among hospitalized patients across the United States, recorded respiratory rates are higher than directly observed measurements and are significantly more likely to be 18 or 20 breaths/min.
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Data from long-term follow-up studies of patients with well-characterized asthma are limited. We studied all-cause and cause-specific mortality and risk factors in a large cohort of adults with asthma. ⋯ This 25-year prospective study of a large cohort of adults with well-characterized asthma showed an excess mortality compared with matched control subjects, to a large extent explained by death from obstructive lung disease.
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Alterations in oxygen transport and use are integral to the development of multiple organ failure; therefore, the ultimate goal of resuscitation is to restore effective tissue oxygenation and cellular metabolism. Hemodynamic monitoring is the cornerstone of management to promptly identify and appropriately manage (impending) organ dysfunction. ⋯ Conversely, the ideal "canary" organ that is readily accessible for monitoring, yet offers an early and sensitive indicator of tissue "unwellness," remains to be firmly identified. This review describes techniques available for real-time monitoring of tissue perfusion and metabolism and highlights novel developments that may complement or even supersede current tools.