In patients with cardiogenic pulmonary edema in the ED, high-flow nasal cannula therapy may decrease the severity of dyspnea during the first hour of treatment.

Study objective: Palliative patients often visit the emergency department (ED) with respiratory distress during their end-of-life period. The goal of management is alleviating dyspnea and providing comfort. High-flow nasal cannula may be an alternative oxygen-delivering method for palliative patients with do-not-intubate status. We therefore aim to compare the efficacy of high-flow nasal cannula with conventional oxygen therapy in improving dyspnea of palliative patients with do-not-intubate status who have hypoxemic respiratory failure in the ED.Methods: This randomized, nonblinded, crossover study was conducted with 48 palliative patients aged 18 years or older with donot-intubate status who presented with hypoxemic respiratory failure to the

Objective: Delayed diagnosis and treatment of shock patients may lead to multiorgan dysfunction syndrome and death. Volume status assessment in shock patients is crucial for guiding early management. Focused echocardiography has become an important tool for assessing volume status because it is non-invasive and easy to perform. We aimed to ascertain the degree of agreement between emergency medicine (EM) residents and a cardiologist on cardiac function evaluations using echocardiography. We also assessed the extent of agreement on pericardial effusion diagnoses. Methods: A cross sectional study was conducted at the Emergency Department, Siriraj Hospital. The EM residents who had limited experience in ultrasound examination underwent a 3-hour echocardiography training course consisting of a lecture and a workshop before starting the study. Patients with shock or suspected hypervolemia were included. Echocardiography was performed by EM residents to evaluate ventricular function of each patients. With visual estimation, they classified the left ventricular function (LVF) into 3 categories: good, moderate and poor. The video files were recorded and re-evaluated by a cardiologist offline. The correlation of left ventricular function estimation and the diagnosis of pericardial effusion between the two operators were determined. Results: Ninety-two patients were enrolled between October and December 2014. The overall agreement of ventricular function assessment between the EM residents and the cardiologist was 79.4% (weighted kappa = 0.73). The degree of agreements of LVF classified as poor, moderate and good LVF were 87.5%, 37.5% and 95% respectively. Moreover, the residents diagnosed the pericardial effusion with 100% accuracy, compared to the cardiologist. Conclusion: Following a short educational training, the EM residents efficiently assessed the left ventricular function with a high level of agreement with a cardiologist.