A moribund and debilitated patient arrives in an emergency department and is placed on life support systems. Subsequently it is determined that she has a 'living will' proscribing aggressive measures should her condition be judged 'terminal' by her physicians. But, as our round table of authorities reveal, the concept of 'terminal' means different things to different people. The patient's surro...

OBJECTIVES To investigate clinical outcomes according to ventilatory support indication in subjects with chronic obstructive pulmonary disease exacerbation in a "real-life" Emergency Department and to analyze potential predictors of successful noninvasive positive pressure ventilation. METHODS Retrospective cohort performed over an 18-month period, comparing the following patient groups with ...

Effectiveness of Decision Support Systems (DSS’s) is enhanced through dynamic adaptation of support to the needs of the decision maker, to the problem, and to the decision context. We define this enhanced DSS’s as Adaptive Decision Support Systems (ADSS’s) and propose its architecture. In an ADSS, the decision maker controls the decision process. However, the system monitors the process to matc...

ASPIRIN poisoning is responsible for over 200 deaths per annum in England and Wales. Forced alkaline diuresis is advocated to hasten renal elimination of the drug when plasma salicylate levels exceed 500 mg/l, whilst charcoal haemoperfusion is the treatment of choice when plasma salicylate levels exceed 900 mg/kg.' This severity of poisoning causes gross respiratory, metabolic and coagulation d...

We studied 118 patients with prolonged critical illness to determine if there would be a difference in outcome between patients managed by university-based (UB) or community-based (CB) intensivists. Patients consecutively admitted to a long-term acute care hospital were assigned in an arbitrary manner to the UB service or CB service. Patient survival, length of stay, and success and length of t...

Withdrawal of life support is an option for patients with prolonged mechanical ventilation when all attempts at weaning have failed and it is deemed futile to continue the therapy, when quality of life is unacceptable, or when it is perceived that the patient is suffering. The purpose of this article is to present the nursing aspects of managing an adult patient undergoing the withdrawal of mec...