Critical care clinics
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Critical care clinics · Jan 2011
ReviewAntimicrobial therapy for life-threatening infections: speed is life.
For decades, health care workers faced the challenge of how to adequately treat life-threatening infections. To a great extent, the primary focus on improving outcomes has centered on improvement in resuscitation, deployment of antimicrobials of increasing potency, and development of novel adjunctive therapies. However, the current studies conclusively show that early recognition of life threatening infection and rapid initiation of appropriate antimicrobial therapy is the critical element in reducing mortality. If "Time is tissue" when it comes to thrombolytic therapy for acute myocardial infarction and thrombotic stroke, then an appropriate rule for life-threatening infections, particularly septic shock, is "Speed is life."
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Critical care clinics · Oct 2010
ReviewIndirect calorimetry measurements in the ventilated critically ill patient: facts and controversies--the heat is on.
The provision of nutrition to critically ill patients in the ICU often receives lower priority compared with hemodynamic and ventilation control. This frequently results in a significant calorie deficit. Overestimation of daily energy expenditure may also result in adverse outcomes. ⋯ Nevertheless, the use of indirect calorimetry has been limited owing to costs and technical difficulties. Controversies about its actual clinical benefits are the focus of recent clinical studies and recommendations. The aim of this review was to describe the advantages of measuring indirect calorimetry within the concept of energy-protein goal-oriented therapy.
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As the incidence of bariatric surgery continues to increase, the medical community should be aware of the most common procedures, resultant anatomy, and possible complications to be better prepared to care for these patients in all situations.
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The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters.