Emergency medicine clinics of North America
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There have been numerous advances in the application of positive pressure mechanical ventilation in the last two decades. As knowledge of pulmonary physiology expands, the application of modes and parameters to maximize the efficacy and minimize the complications of ventilatory support continues to advance. As the use of noninvasive ventilation becomes more widespread, its usefulness in certain clinical entities such as COPD exacerbations and acute cardiogenic pulmonary edema will become more prominent. The role of specific modes and parameters of these devices likely will be further refined to maximize outcomes.
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Emerg. Med. Clin. North Am. · May 2003
ReviewPulmonary trauma emergency department evaluation and management.
Pulmonary trauma is a significant cause of morbidity and mortality in the United States. It is imperative for the emergency physician to identify promptly patients who require immediate therapy. ⋯ This rise in respiratory injuries will require a more aggressive approach of patients with minimal morbidity and mortality. A systematic approach to respiratory injuries is crucial to improving patient outcomes.
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Emerg. Med. Clin. North Am. · May 2003
ReviewEnvironmental insults: smoke inhalation, submersion, diving, and high altitude.
In the expanding search for recreation, we spend more and more of our time in various environments. Whether the air is thin or compressed or smoke-filled or there is no air at all, emergency physicians continue to meet and treat the various pulmonary emergencies that the environment may create. The authors present the background, diagnosis, and management of a few of the more common pulmonary emergencies that the environment may produce.
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Pulmonary edema is differentiated into two categories--cardiogenic and noncardiogenic. Noncardiogenic pulmonary edema is due to changes in permeability of the pulmonary capillary membrane as a result of either a direct or an indirect pathologic process. ⋯ Newer ventilation techniques, such as high-frequency oscillatory ventilation and partial fluid ventilation, are promising but are in the early stages of clinical testing. Mortality rates remain high despite increasing intensive care unit care.
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Asthma is a chronic inflammatory illness with acute exacerbations, which often is encountered in the ED setting. Knowledge of the presentation and treatment of asthma is crucial for any physician treating patients with this disease. Beta-agonist, anticholinergic, and corticosteroid therapy continue to be the mainstay of emergency therapy despite advances in newer medications. Proper attention to long-term treatment of asthma and aggressive treatment of acute exacerbations should help reduce morbidity and mortality.