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Current Issues

Emergency Medicine Practice

Noninvasive Ventilation For Patients In Acute Respiratory Distress: An Update

Abstract:
Emergency Medicine PracticeOver the last 20 years, noninvasive ventilation (NIV) strategies have been used with increasing frequency. The ease of use of NIV makes it applicable to patients presenting in a variety of types of respiratory distress. In this review, the physiology of positive pressure ventilation is discussed, including indications, contraindications, and options for mask type and fit. Characteristics of patients who are most likely to benefit from NIV are reviewed, including those in respiratory distress from chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema. The literature for other respiratory pathologies where NIV may be used, such as in asthma exacerbation, pediatric patients, and community-acquired pneumonia, is also reviewed. Controversies and potential future applications of NIV are presented.

POINTS

  • Noninvasive ventilation (NIV) relies on the creation of consistent positive airway pressure that results in increased laminar flow, stenting open airways and eliminating dead space. This improves lung filling and directly increases minute ventilation by increasing functional residual capacity and tidal volume.
  • NIV is not a definitive airway, but can often be used to optimize a patient’s respiratory condition without intubation. This is especially useful in patients with do-not-intubate orders.

PEARLS

  • NIV can offer rapid resuscitation of the critically ill in the ED and avoid ICU admission.

Pediatric Emergency Medicine Practice

Diphtheria, Pertussis, And Tetanus: Evidence-Based Management Of Pediatric Patients In The Emergency Department

Abstract:
Pediatric Emergency Medicine PracticeDiphtheria, pertussis, and tetanus are potentially deadly bacterial infections that are largely preventable through vaccination, though they remain in the population. This issue reviews the epidemiology, pathophysiology, diagnosis, and current recommended emergency management of these conditions. Disease-specific medications, as well as treatment of the secondary complications, are examined in light of the best current evidence. Resources include obtaining diphtheria antitoxin from the United States Centers for Disease Control and Prevention and best-practice recommendations with regard to testing, involvement of government health agencies, isolation of the patient, and identification and treatment of close contacts. Most importantly, issues regarding vaccination and prevention are highlighted.

POINTS

  • Cases of diphtheria, pertussis, and tetanus should be immediately reported to the state Department of Health or United States Centers for Disease Control and Prevention (CDC).
  • The pseudomembrane site of diphtheria is a source of toxin production that can spread via the bloodstream to other tissues in the body. The extent of the membrane is an indicator of the severity of the illness.

PEARLS

  • Lack of vaccination or a travel history is not essential for the diagnosis of these diseases.

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EMplify, the new Emergency Medicine Practice podcast, is now available

 

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Last Modified: 02/24/2017
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