Correlation of Inferior Vena Cava Respiratory Variability Index with Central Venous Pressure and Hemodynamic Parameters in Ventilated Pigs with Septic Shock

Septic shock is a common critical condition, for which effective early fluid resuscitation is the therapeutic focus. According to the 2008 international guidelines for management of severe sepsis and septic shock, resuscitation should achieve a central venous pressure （CVP） of 8-12 mmHg within the first 6 h. However, it is still uncertain about the sensitivity and specificity of CVP in reflecting the cardiac preload. Ultrasonography is a simple, rapid, non-invasive, and repeatable method for the measurement of sensitivity and specificity of CVP and has thus gradually attracted the increasing attention of physicians. It was reported that ultrasonography can show the inferior vena cava diameter, respiratory variability index, and blood volume in patients with sepsis or heart failure.

Management considerations following overdoses of modified-release morphine preparations

Analgesics have consistently remained the most common substance involved in human poisonings in the United States, with immediate action opioid analgesics associated with the greatest percent of fatalities per exposure.

在基层医疗机构预测肺栓塞补充决策标准，而非取代临床判断

现在是下午4：30，你今天最后接诊的是一位健康状态良好的42岁女性患者，她主诉右肩胛区疼痛，深吸气时疼痛加重。患者说无呼吸困难、咳嗽、发热或近期长期卧床。她的生命体征和体格检查无异常。你的初步印象是某种类型肌肉骨骼病变引起了她的疼痛。然后你开始思考。这可能是肺栓塞吗？

“小病挂急诊”背后的患者困境对大多数人来说，这是应对其他医疗照护资源不足的合理选择，也是最后的选择

世界各地急诊挂号的人数不断上升，等待救治的患者持续增加，患者躺在走廊的担架上，急诊科工作人员在超负荷运转的同时承受着巨大压力。我们常常把急诊科过度拥挤的原因归咎于患者“看小病挂急诊”。这些患者既没有去看他们的全科医生，又不做在线咨询，

疑似阑尾炎患者术前行CT扫描的危害

在本短文中，我们比较了术前行CT扫描来确诊阑尾炎，而非基于外科医生的临床判断，行直接手术的风险和获益。我们得出以下结论，普遍行CT检查的益处是避免了12例不必要的阑尾切除术，但是这12例不手术的代价是CT扫描将导致1例患者因肿瘤死亡。

当医院改用电子病历如果不出错，就是一切都好吗？

在相关论文中，Barnett及其同事研究了最容易造成医院混乱的事件（doi：10．1136／bmj．i3835，摘要见本期第619页），既不是大规模人员伤亡的事故，也不是自然灾害，而是启用新的电子病历系统（electronic health record, EHR） 。