Advertisement
Organ Donation in the ED

Organ Donation in the ED

Emergency physicians (EPs) are at the forefront of efforts to save patients or preserve options for organ donation for those who cannot be saved. On average, 18 Americans die every day while waiting for transplantable organs. Studies suggest that identifying potential organs for donation early from the ED may help increase organ procurement. However, there is little data that takes into account ethical viewpoints when it comes to organ procurement in the ED, according to Arvind Venkat, MD. Current organ donor protocols mandate that patients be referred to the local organ procurement organization (OPO) even when the resuscitative process is just beginning, and the prognosis may still be in doubt. “If death is likely, EPs are expected to continue existing measures or implement new measures to preserve the option of organ donation until OPO representatives arrive,” explains Dr. Venkat. “Under current referral policies, EPs may feel precluded from communicating directly with patients’ families about the rationale for aggressive treatments to preserve the option of organ donation when the opportunity for curing the patient has passed.” This can be especially burdensome at times of high ED and ICU volume and when delays occur.   Seeking Practical Solutions “EPs should be allowed to have honest and forthright communication with families about the status of patients who are viewed as potential organ donors and when OPO referrals have taken place,” Dr. Venkat says. Regardless of whether or not OPO representatives are present, open communication should include: ♦  An explanation of the resuscitative efforts. ♦  The patient’s likely prognosis. ♦  An honest description of options in the dying process. With open communication, family...
SCCM 2015

SCCM 2015

New research was presented at SCCM 2015, the Annual Congress of the Society of Critical Care Medicine, from January 17 to 23 in Phoenix. The features below highlight some of the studies emerging from the conference that are relevant to emergency physicians. Advanced Directives & Intubated ED Non-Survivors The Particulars: Studies have shown that patients who are intubated in the ED have a high in-hospital mortality rate. However, little is known about the impact of advance directives on mortality. Data Breakdown: Patients intubated in the ED who died before hospital discharge were reviewed in a study to calculate the proportion of those who received at least one code, had a do not resuscitate (DNR) order, and/or had care withdrawn. Within 48 hours of admission, 72% of patients had died, 40% had received at least one code, and 59% ultimately had care withdrawn. A DNR order was placed during the hospital course for 17% of patients. Take Home Pearl: The majority of patients intubated in the ED who do not survive appear to die within 48 hours, and many ultimately have care withdrawn. A Look at ED Visits Attributed to Rape The Particulars: In the United States, data are lacking on the impact of rape on medical care and outcomes. Nationally representative epidemiologic estimates of ED visits attributed to rape may shed some light on this research gap. Data Breakdown: For a study, researchers analyzed all ED visits with an external cause of injury code for rape using the Nationwide Emergency Department Sample. Between 2008 and 2010, nearly 50,000 ED visits were attributed to rape. Approximately 65% of rape victims...

Surgery in Space: I Foresee Problems

The astronauts are halfway to Mars when suddenly one of them develops abdominal pain and requires surgery. What will they do? According to NASA, a miniature robot capable of assisting in surgery has been developed, tested in pigs, and is soon to be trialed in a weightless environment. The robot, which weighs less than 1 pound, can be inserted into the abdomen via the umbilicus and controlled remotely. The press release from NASA said types of operations that the robot would be capable of performing were “emergency appendectomies, emergency cholecystectomies, emergency perforation of gastric ulcers [sic], and intra-abdominal bleeding due to trauma.” NASA meant to say “repair of perforated gastric ulcers.” Not surprisingly, many science reporters for media outlets, for example, SFGate and WiredUK, did not notice the error. New Scientist also missed it, but at least published a later correction. However, even the famous da Vinci robot is incapable of performing surgery on its own. The original idea was that a surgeon on the ground would direct the robot’s movements, but that will not be possible for two reasons. In deep space, the time lag between the earthbound surgeon’s actions and the robot’s response would be too long, and a recent article about remote-controlled drone crashes highlighted the problems that can occur when links are lost or computers malfunction. The plan is to train the astronauts to perform minimally invasive robotic surgery on each other. What could go wrong? A lot. If they are only going to train on simulators and then have to do real surgery in space, they will be completely lost, robot or not. I...
Get Connected

Get Connected

Get the edge on your colleagues by receiving updates directly from the Physician’s Weekly editors in multiple ways. Sign up for our weekly e-newsletter Subscribe to our RSS Feed Like us on Facebook Check us out on Google+ Follow us on Twitter Join the conversation on...
[ HIDE/SHOW ]