Tuesday, January 31, 2006
A quick basic science fix:
The Journal of Internal Medicine has a review on opioids in critical illness. Specifically, it is about the complicated hemodynamic, endocrine, and immunologic effects of endogenous and pharmacologic opioids on the response to critical illness (hemorrhage, sepsis, surgery, etc.). Ultra brief summary: rat studies suggest opioids attenuate the counter-regulatory response to critical illness in bad ways, so are we doing harm by using them in the ICU? There's no answer to this of course, but a plug for ketamine as a hypothetical counterbalance to this hypothetical danger is mentioned.
Gastrointestinal Endoscopy has published a review on feeding tubes in people with advanced illnesses. James Hallenbeck wrote an accompanying editorial & discusses it in his blog at Growth House.
According to my wife, during today's Fresh Air radio show on NPR about Medicare Part D with Dr. Christine Cassel from the American Board of Internal Medicine, they venture into discussing end of life care in the hospital (& the great need for improving it in the US). You can listen to the show on-line if you miss the broadcast.