Emergency
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USPSTF Refrains from Definitive Blood Pressure Screening Recommendation
Panel says more research needed before clear judgments for or against screening children, adolescents can be made.
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Rapid Diagnostic Testing in the ED for Mononucleosis, Strep Pharyngitis, Influenza, Respiratory Syncytial Virus, and Procalcitonin
Clinicians strive to use the most accurate tests available while also considering other factors, such as cost, ease of use, and turnaround time for results. It is important to understand the limitations of a test while interpreting the results. This issue will deal with a few of the most common rapid or point-of-care tests used in the emergency department.
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Flu Shot Can Reduce Adverse Heart Outcomes
Those with heart disease can lower their risk of death or other serious complications by receiving the influenza vaccine.
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Norepinephrine Infusion Through Peripheral Intravenous Lines: Is it Safe?
In a large perioperative patient population, norepinephrine infusion through peripheral intravenous lines did not result in any significant adverse events. However, the specific patient population, limited duration of infusion, and hospital setting may limit the generalizability of these findings.
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Do We Really Know the Optimal Oxygen Target in Patients with ARDS?
In the LOCO2 study, a conservative oxygen strategy with SpO2 goals of 88% to 92% was not shown to improve mortality over a liberal oxygen strategy as hypothesized, but rather was found to have a worrisome signal of increased mortality and increased mesenteric ischemia.
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Management of Pulmonary-Renal Syndrome
The role of the intensivist in the management of pulmonary-renal syndrome includes appropriate respiratory support and recognition and management of concurrent infection, hypovolemia, acute anemia, and coagulopathy.
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New Approaches for Ethically Challenging ED Cases
For emergency providers, time is precious. If a full-blown consult is not possible, ethicists can help discern the most critical aspect of a concern these clinicians may express. Quick, in-person responses; phone consults; and telemedicine consults all are possible approaches.
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End-of-Life Care Should Not Vary Depending on Provider
Clinicians must be careful about imposing medical staff priorities over patients’ priorities. Making presumptions is dangerous. Ethicists can help by explaining the provider’s responsibility to offer accurate information.
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Physicians Reported Moral Distress About Surrogate Decision-Makers
Parties clash regarding comfort levels and how aggressive treatment should be. The lack of advance directives for so many patients exacerbates the problem. Nurses and other colleagues can join the conversations to assist or outright substitute for physicians who are unwilling or unable to engage deeply.
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Communicate Collaboratively Before End-of-Life Care Conversations Disintegrate
Once communication breaks down, it is difficult to rebuild. Clinicians, ethicists, and palliative care all should be talking to each other to be sure the family hears a common message.