Critical care clinics
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Bedside fiberoptic bronchoscopy is a valuable tool in the diagnosis and treatment of various respiratory conditions in critically ill patients. The fiberoptic bronchoscope allows direct airway inspection, facilitating the diagnosis of benign and malignant airway lesions. ⋯ The fiberoptic bronchoscope can be used for therapeutic interventions, such as insertion of an endotracheal tube, removal of an aspirated foreign body, clearance of tenacious secretions, promotion of hemostasis in patients with hemoptysis, instillation of drugs, and assistance in the placement of tracheobronchial prostheses (i.e., airway stents). If proper preprocedural training and planning are done and the patient is monitored carefully during the procedure, fiberoptic bronchoscopy can be performed quickly and safely at the bedside in most critically ill patients.
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Orthopedic bedside procedures commonly are performed and are appropriate. As the complexity of patient needs increases and resources are stretched, more patient care, including orthopedic procedures, will be performed in cost-effective but safe environments such as the monitored intensive care setting. ⋯ The decision to perform a specific procedure on a specific patient in a specific environment requires careful consideration of the risk to benefit ratio. This consideration should involve the patient, the physicians, and the entire health care team.
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The improved technical sophistication of laparoscopy offers an attractive highly accurate diagnostic modality at the bedside for critically ill patients who are confined to the ICU and intensive monitoring unit and who are in need of timely abdominal evaluation. If the surgeon understands the physiologic effects of peritoneal insufflation and considers them during the procedure, the patient tolerates the procedure well. It is important to limit insufflation pressures and laparoscopy time. ⋯ Its primary use is diagnostic in penetrating and blunt trauma and in the obscure abdomen. It has been successfully employed therapeutically for acalculous cholecystitis, abscess drainage, and correction of placement of gastrostomy tubes and peritoneal dialysis catheters. It helps avoid risky transport trips and negative or nontherapeutic laparotomy with its known associated risks.
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Critical care clinics · Jan 2000
Bedside procedures. Solutions to the pitfalls of intrahospital transport.
The technology to perform diagnostic and therapeutic procedures at the bedside continues to advance. Because of documented hazards and the expense of intrahospital transport, the bedside is becoming an appealing site for procedures that are more commonly performed in radiologic, bronchoscopic, other procedural suites, and the operating room.