J Emerg Med
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The term adult respiratory distress syndrome (ARDS) was first introduced by Ashbaugh and Petty more than two decades ago. Since then, our understanding of this clinicopathologic entity has increased significantly. However, little therapeutic progress has been achieved, and the mortality remains high. ⋯ The mainstay of therapy for this syndrome is the management of the underlying disorder causing it. To date, there are no specific pharmacologic interventions of proven value for the treatment of ARDS. Once the potentially treatable sources have been found and their therapy started, the main treatment for ARDS is supportive.
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It seems self-evident that the establishment of 24-hour per day attending physician coverage in a teaching hospital's emergency department would enhance risk management. However, prior to this study, little investigation had been done to corroborate the effects of full-time emergency department attending physician coverage. In a retrospective study from a large teaching hospital's emergency department, malpractice claims filed for 1985-1987 (part-time attending physician coverage) were analyzed and compared to those for 1987-1989 (full-time attending physician coverage). ⋯ Attending physician presence increased from 6000 hours per year in 1985-1987 to 26,280 hours per year in 1987-1989. There was an 18.5% decrease in claims filed, and a 70.1% decrease in disbursements for the first 2 years after the introduction of full-time attending physician coverage as compared with the preceding 2 years. These findings suggest that full-time attending physician coverage in the emergency department is associated with improved risk management.
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Internal medicine is an essential but diverse field. This is the second in a three-part set of objectives for an off-service rotation in general internal medicine. This series may be used to guide the resident during the rotation or to serve as part of a teaching program integrated with didactic training and emergency department experience.