Intensive care medicine
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Critical care physicians are frequently confronted with intoxicated patients who have used street drugs. In the last decade there has been an upward trend in the use of these substances, particularly amongst adolescents and young adults in large urban areas. ⋯ Early and appropriate medical attention by emergency medicine physicians and intensivists can improve outcomes. In this review article we intend to familiarize critical care physicians with the most common street drugs such as amphetamines, ecstasy, cocaine, gamma hydroxybutyrate, opioids, and phencyclidine.
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Intensive care medicine · Aug 2004
Comparative StudyConsciousness monitoring in ventilated patients: bispectral EEG monitors arousal not delirium.
Bispectral index (BIS) is being evaluated as a monitor of consciousness, yet it is unclear what components of consciousness (i.e., arousal vs. content of consciousness) the BIS measures. This study compared BIS levels to well-validated clinical measures of arousal and the presence or absence of delirium. ⋯ In comparison with clinical measures of arousal in mechanically ventilated patients, BIS-XP algorithm demonstrated stronger correlation with RASS levels than did BIS 3.4, yet marked overlap across different levels of arousal persist using both algorithms. After controlling for level of arousal, neither BIS-XP nor BIS 3.4 algorithms distinguished between the presence and absence of delirium.
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Intensive care medicine · Aug 2004
Use of oral clonidine for sedation in ventilated paediatric intensive care patients.
We aimed to document our experience with oral clonidine when used as a sedative in combination with intravenous morphine and lorazepam in a group of mechanically ventilated children with single-organ, respiratory failure. In particular, our objectives were to establish the relationship between oral dose, plasma concentration, and sedative effect, and second, to document the side-effect profile. ⋯ Oral clonidine may be a safe and effective sedative in combination with morphine and lorazepam for young children with single-organ, respiratory failure. This agent may also exhibit opioid and benzodiazepine sparing effects in this patient group. A full pharmacokinetic study is warranted.
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Intensive care medicine · Aug 2004
Monitoring midline shift by transcranial color-coded sonography in traumatic brain injury. A comparison with cranial computerized tomography.
Transcranial color-coded duplex sonography (TCCDS) is a non invasive bedside technique that allows the determination of midline shift (MLS). The purpose of our study was to compare MLS measurements using TCCDS with those obtained with cranial computerized tomography (CT) in patients with traumatic brain injury (TBI). ⋯ The TCCDS is a non-invasive bedside technique that is valid for determining MLS in patients with traumatic brain injury. Due to the risks involved in the transportation of traumatic brain-injured patients to the radiology department, this bedside technique is specially interesting in these patients.
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Intensive care medicine · Aug 2004
Continuous central venous and pulmonary artery oxygen saturation monitoring in the critically ill.
To compare the course of continuously measured mixed and central venous O(2) saturations in high-risk patients and to evaluate the impact of various factors that might interfere with reflection spectrophotometry. ⋯ Continuous fiberoptic measurement of central vein O(2) saturation has potential to be a reliable and convenient tool which could rapidly warn of acute change in the oxygen supply/demand ratio of critically ill patients.