Hospital practice (1995)
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Hospital practice (1995) · Jun 2000
Case ReportsWithholding or withdrawal of life-sustaining therapy.
Seventy percent of deaths in intensive care units are preceded by decisions to limit life-support, most of which are made in consultation with the patient's family or other surrogates. Even when the outcome is clear, surrogates and physicians may deny that death is imminent and delay removing ventilatory assistance and other supportive measures. To avoid prolonging suffering, end-of-life decisions should always be guided by the interests and wishes of the patient.
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A 62-year-old man presented to the emergency department with a one-week history of subjective fever and rigors. He had had epigastric pain for three weeks, for which he was taking ranitidine, and in the past two to three months had experienced night sweats, a nonproductive cough, nausea, vomiting, and a 30-lb weight loss. He denied dsypnea, chest pain, hematochezia, melena, or any change in bowel habits.
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A 47-year-old man who smelled of alcohol presented with a three-day history of sore throat. He had not had fever, nausea, vomiting, diarrhea, rhinorrhea, cough, chest pain, or palpitations. On evaluation in the emergency department, he was found to have tachycardia and an irregular pulse.