Current opinion in anaesthesiology
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There are significant misunderstandings about the management of perioperative do-not-resuscitate orders. This paper reviews some of the difficulties generated by the halting acceptance and inconsistent implementation of an ethically appropriate perioperative do-not-resuscitate policy that mandates reconsideration of existing do-not-resuscitate orders. It also offers strategies for empowerment of such a policy. ⋯ A well written perioperative do-not-resuscitate policy is essential for surmounting obstacles to a well functioning perioperative do-not-resuscitate system.
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Ensuring quality in prehospital airway management is challenging because the out-of-hospital setting is a fast-paced and unpredictable environment. The first step in meeting this challenge is the recognition by emergency medical service leaders that prehospital airway management is prone to error. Quality core values such as safety, effectiveness, timeliness, efficiency, and equity for prehospital airway management, specifically endotracheal intubation, will be discussed. ⋯ Emergency medical service administrators must critically evaluate the quality of prehospital airway management that they are providing to patients within their system by collecting the data necessary to identify quality issues and developing strategies to implement change. Research into other techniques that can provide ventilation and oxygenation to patients in the prehospital environment and that are safe and effective, such as laryngeal mask airway, need to be performed.
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Curr Opin Anaesthesiol · Apr 2003
Treatment of sepsis and septic shock: is there a light at the end of the tunnel?
For years, the field of sepsis research was extremely active; the net result, however, was rather disappointing. Sepsis is still a major problem in intensive care units worldwide. Frustratingly, sepsis is characterized by a high morbidity and mortality. Although multiple (animal) studies with promising results have been published, the clinical situation has changed only a little. However, the recent 2 or 3 years of sepsis research brought significant results that will have a significant impact on clinical routine. ⋯ A breakthrough in sepsis research was long awaited. Recent clinical studies demonstrated that an improvement in outcome can be achieved even with simple means. This review focuses on these new therapeutic concepts, hopefully helping to transfer scientific advantages into everyday clinical routine.
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End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002. ⋯ The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.
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To summarize current knowledge on pathophysiology and treatment of drowning accidents. Studies and case reports were searched using the keywords drowning, near-drowning, asphyxia, hypoxia and hypothermia in conjunction with organ systems and specific treatment options. ⋯ Several case studies have convincingly demonstrated that drowning victims may survive neurologically intact even after prolonged submersion times, in particular in cold water. Therefore, aggressive initial therapeutic efforts are indicated in most near-drowning victims.