Can J Emerg Med
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It is important for clinicians to be aware of the sensitivity and limitations of commonly used methods to confirm endotracheal tube placement. Overreliance on insensitive indicators can lead to delayed recognition of esophageal intubation. The case presented highlights this concern.
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To determine if peripheral venous blood gas values for pH, partial pressure of carbon dioxide (Pco(2)) and the resultant calculated bicarbonate (HCO(3)) predict arterial values accurately enough to replace them in a clinical setting. ⋯ Arterial and venous blood gas samples were strongly correlated, and there were only small differences between them. A survey of emergency physicians suggested that the differences are too large to allow for interchangeability of results; however, venous values may be valid if used in conjunction with a correction factor or for trending purposes.
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Poisoning is an uncommon but potentially fatal outcome of toxic alcohol ingestion. The toxic alcohols methanol, ethylene glycol and isopropyl alcohol are commonly found in household and commercial products. Because the toxic effects are caused by the metabolites of methanol and ethylene glycol rather than the agents themselves, there is often a substantial delay between ingestion and onset of clinical toxicity. ⋯ The pitfalls of using these tests to rule out alcohol ingestion are reviewed. Ethanol infusion is the traditional therapy for such overdoses. In addition to the pathophysiology and clinical findings in poisoning, recent evidence for the use of fomepizole and adjuvant therapies is reviewed.
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Ethical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions. ⋯ Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient's wishes, that it is achievable, and that competing claims for the same resource are considered. Learning from others' experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues.