Cleveland Clinic journal of medicine
-
Internists are commonly consulted to "clear" patients for anesthesia and surgery. Newer anesthetic agents and techniques now extend limits and possibilities beyond what many internists were taught. ⋯ Postoperative care will likely assume increasing importance in determining anesthesia-related morbidity and mortality. For this reason, increased interaction and cooperation between surgeons, internists, and anesthesiologists are needed.
-
What are a physician's ethical responsibilities when a patient or surrogate demands futile life-saving treatment? Recent attempts to define medical futility have implications for physician responsibility and may create exceptions to acquiring patient consent. Wording is proposed for a "futility clause" for use in do-not-resuscitate policies.
-
Gram-negative bacterial infections are difficult to control and often lead to septic shock or septic syndrome. Many physiologic changes in sepsis are due to bacterial triggering of host responses. ⋯ New therapeutic agents are currently being evaluated in animal and human studies. By combining these advances with adequate antibiotic therapy, it may be possible to improve overall survival in patients with gram-negative sepsis.
-
In 1988, a new do-not-resuscitate policy aimed at assisting professional staff, nurses, patients, and families in end-of-life choices replaced the existing policy at The Cleveland Clinic Foundation. We conducted a retrospective chart review to examine the effects of the new policy on length of stay. ⋯ The number of days from writing the order until death did not change significantly from 1987 to 1989. We conclude that a well-defined do-not-resuscitate policy can reduce length of stay.