The American journal of medicine
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Recent reports on the use of in-hospital cardiopulmonary resuscitation (CPR) have failed to provide an applicable method to identify patients who have little chance of surviving CPR. We prospectively evaluated the clinical characteristics and outcome of 140 consecutive hospitalized patients who had cardiopulmonary arrest and received CPR, and we propose a method for predicting survival in this setting. ⋯ The PAM Index may be useful in identifying patients in whom CPR may be ineffective.
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The claim that a treatment is futile is often used to justify a shift in the physician's ethical obligations to patients. In clinical situations in which non-futile treatments are available, the physician has an obligation to discuss therapeutic alternatives with the patient. By contrast, a physician is under no obligation to offer, or even to discuss, futile therapies. ⋯ Ambiguity in determining futility, arising from linguistic errors, from statistical misinterpretations, and from disagreements about the goals of therapy, undermines the force of futility claims. Decisions to withhold therapy that is deemed futile, like all treatment choices, must follow both clinical judgments about the chance of success of a therapy and an explicit consideration of the patient's goals for therapy. Futility claims rarely should be used to justify a radical shift in ethical obligations.
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Comparative Study
Value of normal electrocardiographic findings in predicting resting left ventricular function in patients with chest pain and suspected coronary artery disease.
Characterization of left ventricular function is important in managing patients with coronary artery disease. Although many methods are available to assess left ventricular function, most are either expensive, invasive, or both. In this study, we examined the ability of normal or near-normal resting electrocardiographic findings to predict resting left ventricular ejection fraction, measured by resting radionuclide angiography, in 874 patients with chest pain and suspected coronary artery disease. ⋯ Thus, an entirely normal result on a resting 12-lead electrocardiogram in patients with suspected coronary disease but no history of a previous myocardial infarction is a reliable (95%) predictor of normal left ventricular function. If nonspecific ST-T wave abnormalities are noted, particularly if there is a history of a previous infarction, the predictive value of the electrocardiographic findings is diminished.
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Clinicians should be aware that temporal arteritis in blacks has a clinical presentation similar to that found in the white population. Heightened clinical awareness of the possibility of temporal arteritis in black patients should lead to earlier diagnosis and initiation of immunosuppressive therapy, thus helping prevent the severe sequela of blindness that has been documented in about half of the cases of untreated temporal arteritis.