Ethical principles in critical care

Article Abstract:

The most important ethical standard of medicine has traditionally been to benefit the patient by preserving life, treating disease, and reducing pain. Other key principles include doing no harm, respecting patient autonomy (the rights of patients to make decisions about their care), and serving social justice, meaning allocating medical services fairly according to greatest need. These ethical principles are the basis for the relationship between physician and patient and can usually be readily upheld in the doctor's office or during an uncomplicated hospital admission. But this relationship can break down in the intensive care unit (ICU), where a patient's private physician must often turn control over to specialists who have never met the patient and decisions must be made rapidly due to the critical medical condition of the patient. Frequently, patients are not able to express their preferences about treatments physicians wish to use. While these circumstances are difficult, the principles of medical ethics can be applied in the ICU, and are upheld on a daily basis by physicians experienced at working in the critical care setting. In this article, ethical issues are discussed primarily to inform the physician in training and the doctor who rarely treats patients in the ICU. The issues covered are medical decision making, informed consent, resuscitation, brain death and organ transplantation, withholding life support, and allocation of medical resources. Some of the most difficult ethical conflicts could be avoided if individuals would make their wishes for medical care known before an emergency hospital admission; "living wills" are one way of clarifying the patient's wishes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Management, Interpretation and construction, Ethical aspects, Medical ethics, Intensive care units, Critical care medicine, Emergency medicine, Life support systems (Critical care), Life support care

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Effects of dexamethasone on the incidence of acute mountain sickness at two intermediate altitudes

Article Abstract:

The effectiveness of dexamethasone acetate as a treatment for acute mountain sickness (AMS) was tested. Acute mountain sickness (AMS) is caused by high altitudes and involves headache, insomnia, breathing abnormalities, loss of appetite, and fatigue. People were classified as having AMS if they reported three or more of the five symptoms. Subjects at 2,000 and 2,700 meters above sea level were given 4 mg doses of the drug. At 2,700 meters, subjects treated with dexamethasone acetate had half the symptoms and one fifth the rate of AMS. At 2,000 meters, dexamethasone acetate had no effects. Thus, dexamethasone acetate ameliorates the usual symptoms of AMS at higher altitudes, but not at intermediate altitudes (around 2,000 meters).

Care and treatment, Physiological aspects, Dosage and administration, Dexamethasone, Altitude, Influence of, Mountain sickness, Altitude sickness

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Management of Dyspnea in Patients With Far-Advanced Lung Disease: "Once I Lose It, It's Kind of Hard to Catch It..."

Article Abstract:

Patients with chronic shortness of breath caused by lung disease should make a living will detailing whether they want to be placed on a ventilator and other issues. Two case reports are used to illustrate the process.

Case studies, Terminal care, Lung diseases

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