Critical care medicine
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Critical care medicine · Apr 2009
Epinephrine reduces cerebral perfusion during cardiopulmonary resuscitation.
Epinephrine has been the primary drug for cardiopulmonary resuscitation (CPR) for more than a century. The therapeutic rationale was to restore threshold levels of myocardial and cerebral blood flows by its alpha1 (alpha1) and alpha2 (alpha2)-adrenergic agonist vasopressor actions. On the basis of coincidental observations on changes in microvascular flow in the cerebral cortex, we hypothesized that epinephrine selectively decreases microvascular flow. ⋯ In this model, epinephrine through its alpha1-agonist action had adverse effects on cerebral microvascular blood flow such as to increase the severity of cerebral ischemia during CPR.
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Critical care medicine · Apr 2009
Extracorporeal life support for support of children with malignancy and respiratory or cardiac failure: The extracorporeal life support experience.
Extracorporeal life support (ECLS) is a means of respiratory and hemodynamic support for patients failing conventional therapies. Children with cancer who develop complications during therapy may require ECLS. ⋯ Children with cancer and respiratory failure can be offered ECLS with a reasonable expectation for survival. The opinions of the ELSO center suggest that decisions to offer ECLS to a child with malignancy should be made on a case by case basis, with prognosis of the malignancy being an important factor.
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The Hippocratic Oath states "... I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect" (http://en.wikipedia.org/wiki/Hippocratic_Oath ). Physician-assisted suicide and euthanasia are topics that engender a strong negative response on the part of many physicians and patients. This article explores contributions of religion, Western medical mores, law, and emerging concepts of moral neurocognition that may explain our inherent aversion to these ideas. ⋯ Our collective repudiation of physician-assisted death, in all its forms, has complex origins that are not necessarily rational. If great care is taken to ensure that a request for physician-assisted death is persistent despite exhaustion of all available therapeutic modalities, then an argument can be made that our rejection constrains unnecessarily the liberty of a small number of patients.