Emergency medicine

Article Abstract:

Cardiopulmonary resuscitation remains, at present, a spectacular failure. Only a small minority of patients are successfully resuscitated, and much research effort is being expended to improve these results. Some evidence suggests that the doses of epinephrine (adrenalin) that are given to cardiac arrest victims may simply be inadequate to produce the blood pressures necessary to get the system started again. Larger doses may prove more effective in the future. A more aggressive approach to saving victims of cardiac arrest may be immediate coronary artery bypass surgery. In one study, patients with ventricular fibrillation (uncoordinated movement of the heart muscle, resulting in insufficient flow of blood) were operated on within 20 minutes; the survival rate was 100 percent. The brain is deprived of oxygen during cardiac arrest, which may result in neurological damage. Efforts are underway to learn how to minimize damage to the brain in these cases. It is believed that much of the damage results as the restored circulation brings fresh oxygen to brain cells that are vulnerable from the ischemic (oxygen-starved) insult. Preliminary attempts to lessen this damage have proved unsuccessful. Another aspect of emergency care under discussion is the practice of 'load and go' ambulance care. Some people feel that getting the patient to the hospital as quickly as possible is the best choice, while others feel that some time should be taken to evaluate and possibly begin treatment before the patient is brought to the emergency room. One study found that paramedics were able to obtain a diagnostic quality electrocardiogram (ECG) in 98 percent of cases; the accurate and rapid identification of patients suffering from a heart attack may expedite the treatment of the patient upon arrival to the emergency room. (Consumer Summary produced by Reliance Medical Information, Inc.)

Traumatology, Medical emergencies, Emergency medicine, Disaster medicine

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Critical care medicine

Article Abstract:

An importance condition in the practice of critical care medicine is acute lung injury, also known as adult respiratory distress syndrome. The fatality rate for acute lung injury is about 60 percent, but it varies tremendously depending upon the underlying cause of the injury. For example, acute lung injury resulting from a fat embolism has a mortality rate of about 10 percent, while acute lung injury resulting from bacterial infection of the blood has a mortality rate approaching 90 percent. New strategies are being developed to reduce the lung damage and improve the survival of patients with acute lung injury resulting from sepsis (a condition resulting from bacteria in the blood). Immunotherapy may play a key role. Bacteria of the group known as gram negative usually have molecules called endotoxins that are responsible for much of the tissue damage that results from the infection. While the endotoxin from each gram negative bacteria is different, they have in common a specific molecular portion called lipid A. In a recent study, antibodies that bind to lipid A were given to patients with gram negative sepsis. Thirty percent of the patients who received this special laboratory-prepared human antibody died, in contrast with a 49 percent mortality among the patients who received placebo only. Another important aspect of critical care medicine that deserves attention is the development of better prognostic methods. As it becomes easier to sustain life artificially on machines, it becomes more critical to determine which patients may be successfully weaned from the life support system, and which will die when life support is removed. It is also important to be able to identify patients on life support who will never recover. (Consumer Summary produced by Reliance Medical Information, Inc.)

Acute respiratory distress syndrome, Adult respiratory distress syndrome, Immunotherapy

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Critical care medicine

Article Abstract:

Recent advances in critical care medicine are changing the way practitioners manage mechanical ventilation, the auto-positive end-expiratory pressure (autoPEEP) phenomenon and patients with sepsis. The most important components of critical care medicine are the thorough assessment of problems and the precise administration of care. Previously doctors sought to provide a higher volume of air to patients on ventilators. However, new evidence indicates that this may be a dangerous procedure in critically ill patients with diseased lungs. The management of the autoPEEP response is also gaining more attention as practitioners learn that it can occur not only in patients on ventilators but also spontaneously in patients breathing on their own. Side effects of biological preparations for treating patients with septic shock have shown that cardiovascular therapies will be the treatment of choice. More accurate tools for measuring the rate of fluid flow through an organ or specific area of the body are still needed.

Practice

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