Governmental regulations and radiation exposure.

BACKGROUND: The use of radiation for medical purposes falls under the purview of the Food and Drug Administration (FDA) and individual states. Enhanced regulations are in place to promote the right exam for the right reason at the right time for every patient exposed to medical x-rays. METHODS: The February 2010 FDA initiative to reduce unnecessary radiation exposure from fluoroscopy, CT, and nuclear medicine studies is reviewed along with regulations currently in place. RESULTS: Facilities granting privileges to physicians performing fluoroscopic procedures need to ensure appropriate education so they can assess individual patient risk and benefit on a case-by-case basis. These are guidelines with individual states controlling requirements. CONCLUSION: Regulation of education, training, and credentialing for physician operators of fluoroscopic equipment is currently controlled by individual states and is not uniform. There are strong indications that the FDA and or the Joint Commission will become increasingly involved to increase documentation of patient exposure and safety.

Supportive care in acute respiratory distress syndrome.

Although the central focus of acute respiratory distress syndrome (ARDS) is the pathology within the lung, ARDS is very much a systemic disease. As such, the whole body needs care and support while the disease process within the lung runs its course. The issues of pain management, sedation, fluid balance, nutrition, metabolic and hormonal processes, infection control, and patient positioning are important for any patient in a critical care setting. For patients with ARDS, the required ventilatory support and ARDS-associated systemic inflammation mandate the above supportive measures.