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In a randomized, controlled trial, patients with stroke or head injury who required mechanical ventilation were less likely to develop ventilator-associated pneumonia if they underwent early percutaneous gastrostomy for nutritional support than if they continued to be fed via nasogastric tube.
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Airway Management is an integral and frequent component of care of the critically ill.
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This prospective 10-year study of 7356 patients with ST-elevation MI who presented in cardiogenic shock showed once again that early mechanical revascularization (as recommended by current guidelines) substantially increases survival; it also suggests that adherence to the guidelines needs to be further improved.
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No one can debate that reperfusion therapy with either percutaneous coronary intervention (PCI) or fibrinolysis reduces mortality for patients with ST-segment elevation myocardial infarction (STEMI). Additionally, it has been clearly proven that the shorter the time interval from symptom onset to treatment, the greater the benefit, regardless of which therapy is chosen.
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Effective and timely management of the airway is our paramount responsibility. Once the decision to intubate has been made, the emergency physician faces a number of daunting questions often with little information, no time, and zero tolerance for failure.
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Cardiogenic shock mortality ranges from 50-80% and septic shock 40-60%. The hallmark of shock is inadequate tissue perfusion, a condition that should be addressed immediately and reversed promptly to prevent organ failure and death. The team approach with a mobilization of resources has been well described in specific disease processes such as cardiac arrest and trauma; the authors of this manuscript proposed that all forms of shock deserve the same level of attention.
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Ingestion of foreign bodies is a frequent reason for seeking emergency care in the pediatric population. Coins, in particular, are commonly encountered, and often are lodged in the esophagus. The management in symptomatic children is immediate removal of the coin, usually by endoscopy.
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The 12-lead electrocardiogram (ECG) and accompanying rhythm strip shown in the Figure were obtained from an older man who presented with acute dyspnea from pneumonia. He was on multiple medications, and was in moderate-to-severe respiratory distress at the time this ECG was recorded.
