Internal and emergency medicine
-
Ultrasonography (US) is an invaluable tool in the management of many types of patients in Internal Medicine and Emergency Departments, as it provides rapid, detailed information regarding abdominal organs and the cardiovascular system, and facilitates the assessment and safe drainage of pleural or intra-abdominal fluid and placement of central venous catheters. Bedside US is a common practice in Emergency Departments, Internal Medicine Departments and Intensive Care Units. ⋯ US can be performed at different levels of practice in Internal Medicine, according to the experience of ultrasound practitioners and equipment availability. In this review, the indications for bedside US that can be performed with basic or intermediate US training will be highlighted.
-
Use of etomidate in severe sepsis and septic shock has been challenged in recent literature due to its link to adrenal insufficiency and suspected increased mortality. We hypothesized that etomidate does not contribute to mortality in this patient population. A retrospective chart review of 230 intubated, severe sepsis/septic shock patients at two university tertiary care referral centers was conducted for patients receiving treatment between 12/2001 and 10/2009. ⋯ APACHE II scores were 22 ± 7.2 and 23 ± 7.1 for the etomidate group and the non-etomidate group, respectively, (p = 0.36). There was no significant difference in mortality between etomidate and non-etomidate cohorts in this study. This large retrospective multi-center study further supports the safety of etomidate use in severe sepsis and septic shock.