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R D Brandstetter

Publications and source records attributed to R D Brandstetter.

At least 19 recordsLinked to original sources
PubMed1998

Roentgenographic mimics of pneumonia in the critical care unit.

Clinicians are confronted with a complex challenge when a patient is admitted to a critical care unit (CCU) with a significant chest roentgenography (CXR) abnormality. The etiology of a new infiltrate seen on CXR in a patient already in the CCU is more difficult to establish, but is of equal concern.

Critical Care↗
PubMed1997

A fetal yawn?

Explore the source record for details and available documents.

Female↗
PubMed1997

Aspiration pneumonia. Strategies for early recognition and prevention.

Aspiration is the result of dysfunction during the oral, pharyngeal, or esophageal stage of deglutition. Depending on the type of aspirate, the resultant lung injury may include chemical or bacterial inflammation or obstruction of the airways. Tools for evaluation include roentgenography, upper GI tract studies, bronchoscopy, and esophageal pH studies. Medical management is primarily supportive. Because aspiration pneumonia has a high morbidity rate, prevention involving early recognition and modification of predisposing factors whenever possible is critical for improving outcomes.

Humans↗
PubMed1996

Radiographic mimics of pneumonia. Pulmonary disorders to consider in differential diagnosis.

Pinpointing the source of roentgenographic lung abnormalities can be challenging because many noninfectious pulmonary disorders mimic pneumonia. The authors of this article discuss the most common radiographic presentations of lung disorders that may be mistaken for pneumonia, including focal and diffuse infiltrates, nodules, cavities, and pleural effusion. They also outline the role of thorough history taking and examination in prompt and accurate diagnosis of pulmonary disorders.

Diagnosis, Differential↗
PubMed1995

How to determine decisional capacity in critically ill patients. Presume the patient can make decisions unless proven otherwise.

Decisional capacity includes ability to comprehend information, to make an informed choice, and to communicate that choice; it is specific to the decision at hand. Presume a patient has decisional capacity; an evaluation of incapacity must be justified. Administer a standardized mental status test to help assess alertness, attention, memory, and reasoning ability. A patient scoring below 10 on the Folstein Mini-Mental State Examination (maximum score, 30) probably does not have decisional capacity; one scoring from 10 to 15 probably can designate a proxy but not make complex health care decisions. Obtain psychiatric consultations for a patient who exhibits psychological barriers to decision making.

Amyotrophic Lateral Sclerosis↗
PubMed1995

Using advance directives effectively in the intensive care unit. Terminating care in the presence--or absence--of directives.

When a patient is admitted to the ICU, determine whether the person has decisional capacity and whether an advance directive exists. If so, discuss treatment options and the directive with the patient--as well as with family members and appointed surrogates; clarify the patient's wishes. If no directive has been drawn up, encourage the patient to do so. If a patient lacks decisional capacity but has a directive, determine whether it applies to the current situation. If it does, follow its instructions. If no directive exists or if it does not apply, consult with family members to determine the patient's wishes, and ascertain whether these substitute judgments meet state laws.

Advance Directives↗
PubMed1995

How--and when--to obtain consent for do-not-resuscitate orders. Clinical guidelines and strategies for resolving conflicts.

Consider a do-not-resuscitate (DNR) order when a patient's presumed consent for cardiopulmonary resuscitation (CPR) is in question, the patient has an illness that is terminal or severe and irreversible, or he or she is permanently unconscious or likely to have cardiac or respiratory arrest. The patient with decisional capacity has the right to give or withhold consent for a DNR order. State law may limit a surrogate's authority to request that CPR be withheld. Remember, a DNR order does not restrict a patient's access to intensive care. Nurses, patient advocates, social workers, and clergy members may help mediate disputes. If necessary, seek advice from an ethics committee on how to resolve the conflict.

Cardiopulmonary Resuscitation↗