The American journal of emergency medicine
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The process of shared decision making (SDM) is an ethical imperative in the physician-patient relationship, especially in the emergency department (ED), where SDM can present unique challenges because patients and emergency physicians often have no established relationship and decisions about diagnosis, treatment, and disposition are time dependent. SDM should be guided by the ethical principles of autonomy, beneficence, nonmaleficence, and justice and the related principle of stewardship of finite resources. The objective of this article is to outline the ethical considerations of SDM in the ED in the context of diagnostic evaluations, therapeutic interventions, disposition decisions, and conflict resolution and to explore strategies for reaching decision consensus. ⋯ While respecting patient autonomy, emergency physicians also recognize the importance of the application of professional judgment to achieve the best possible outcome for patients. SDM as an ethical imperative in the context of ED disposition is especially important because of the frequent ambiguity of equipoise in these situations. Unique clinical situations such as pediatric patients or patients who lack decisional capacity merit special consideration.
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Pathophysiology of cardiac arrest corresponds to a whole body ischemia-reperfusion. This phenomenon is usually associated with an oxidative stress in various settings, but few data are available on cardiac arrest in human. The aim of the present study was to evaluate different oxidative stress markers in out-of-hospital cardiac arrest (OHCA) patients treated with therapeutic hypothermia. ⋯ After OHCA, good outcome patients exhibit lower oxidative stress markers than poor outcome patients. Thiobarbituric acid reactive species appears to be an early prognostic parameter. Oxidative stress markers seem not mitigated by therapeutic hypothermia.
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Randomized Controlled Trial
Quality between mechanical compression on reducible stretcher versus manual compression on standard stretcher in small elevator.
Manual cardiopulmonary resuscitation (CPR) during vertical transport in small elevators using standard stretcher for out-of-hospital cardiac arrest can raise concerns with diminishing quality. Mechanical CPR on a reducible stretcher (RS-CPR) that can be shortened in the length was tested to compare the CPR quality with manual CPR on a standard stretcher (SS-CPR). ⋯ Mechanical CPR on a reducible stretcher during vertical transport showed significant improvement in CPR quality in terms of no-flow fraction, compression depth, and rate compared with manual CPR on a standard stretcher.
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Gamma immunoglobulin E (IgE) is associated with allergic reactions but has not been described as being activated after sepsis. This study aimed at detecting the prognostic value of plasma IgE level in sepsis progression in the emergency department (ED). ⋯ The results of this study indicate that septic patients with higher IgE level present with higher risk of mortality, and a combination of IgE level with scoring systems significantly increased the predictive accuracy for severe sepsis and 28-day mortality.
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Multicenter Study
Neurologic outcome of comatose survivors after hanging: a retrospective multicenter study.
The aim of this study is to identify the neurologic outcome of hanging patients and prognostic factors. ⋯ Even though cardiac arrest did not occur after hanging injuries, 7.5% of patients could not recover consciousness. Therapeutic hypothermia should be considered for such patients. If OHCA occurred after the hanging injury, the proportion of patients with good neurologic outcome was very low at 4.1%.