Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Apr 2013
ReviewEthical considerations for discontinuing pacemakers and automatic implantable cardiac defibrillators at the end-of-life.
As the use of intracardiac devices has increased, the awareness of the burdens of the devices, especially the uncomfortable defibrillator shocks, has also increased. Some patients have requested device deactivation and some physicians have expressed reluctance to do so. This review will update physicians about the ethical acceptability of removal of intracardiac devices. ⋯ Physicians ought to initiate a deactivation conversation, ideally at the time of implantation. Sharing case studies about the deactivation process will enable physicians to enhance their ability to guide patients and family through thoughtful decision-making. Guidelines for deactivation should be promulgated throughout institutions that serve patients with intracardiac devices.
-
Diagnosis and treatment of trauma-induced coagulopathy (TIC) presents a challenge for trauma care providers. Viscoelastic tests (VETs) including thromboelastometry and thrombelastography are increasingly used to diagnose TIC and guide hemostatic therapy. We summarize the concept of individualized, goal-directed coagulation management using coagulation factor concentrates. ⋯ VETs are useful in the diagnosis of TIC, allowing precise deficits in the coagulation process to be identified and specifically targeted with coagulation factor concentrates.