Emergency medicine clinics of North America
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This article reviews the critical resuscitations necessary during prehospital and emergency department treatment of cardiac arrest. Standard therapy for cardiac arrest rhythms is presented. Novel pharmacologic agents, types of cardiopulmonary resuscitation, and circulatory-assist devices are discussed.
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Assessment and management of patients with blunt abdominal trauma remains a challenge for emergency physicians. The spectrum of injury ranges from the trivial to the catastrophic and the initial assessment, resuscitation, and investigation of patients with abdominal trauma must be individualized. This article covers the important aspects of patient history and physical examination and addresses the relevant investigative tools available. An approach to the assessment of patients with abdominal trauma is provided; the goal is to diagnose significant injuries as soon as possible and avoid the pitfall of a delayed or missed diagnosis.
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Recent evolution in the thinking of sepsis syndrome has provided a framework on which new clinical and basic research can be built. The separation of the inciting event and the cascade of subsequent physiologic changes has profound effects on how sepsis is thought of and ultimately how it will be treated. Early identification and treatment of infections and identifying patients at risk, to prevent SIRS, is the current role of Eps. ⋯ Modulation of the inflammatory response appears to be a prime prospect, but its practicality remains to be proved. Research and future roles of EPs include defining the population of ED patients at risk for SIRS and use of mediators of the inflammatory response. Emergency medicine is positioned in a critical point in the care of these patients.
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This article examines a number of areas in emergency prehospital care that the authors view as important and controversial. It offers a Canadian perspective on international research done in the field of prehospital care, and it is not intended to suggest recommendations for the American prehospital care environment. The discussion is not encyclopedic. The authors believe that the areas discussed merit further research and analysis.
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Many ethical issues in emergency medicine involve the question of informed consent. In this article, the ethical basis for informed consent, the essential elements of a morally valid informed consent, and the inadequacy of the law as a moral guide for informed consent are discussed. The ways in which the nature of emergency medicine affects the application of moral principles are examined, and specific guidelines for assessing a patient's decision-making capacity regarding informed consent are provided.