Critical care clinics
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The use of ultrasound to mark landmarks for diagnostic lumbar puncture has been described in emergency medicine as well as in the anesthesia literature. One of the most difficult scenarios arises when obese patients with a body mass index (BMI) of greater than 30 present to an acute care setting, such as the emergency department or intensive care unit and require diagnostic LP. This article discusses lumbar puncture in patients with a high BMI.
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Critical care clinics · Oct 2010
ReviewVenous thromboembolic disease and hematologic considerations in obesity.
Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes.
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Any patient can have a difficult airway, but obese patients have anatomic and physiologic features that can make airway management particularly challenging. Obesity does not seem to be an independent risk factor for difficult intubation but is one of the several factors that need to be considered as part of an airway evaluation. To effectively manage airways in obese patients, health care providers working in the intensive care unit setting must be proficient in airway evaluation and management in all types of patients. This article discusses the risk factors for a difficult airway and the methods of managing the airway.
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Critical care clinics · Jul 2010
ReviewThe evolutionary role of nutrition and metabolic support in critical illness.
Maintenance of nutritional status is particularly challenging during critical illness. There is a common perception of a race against the clock to adequately feed the patient to prevent or minimize the sometimes catastrophic muscle wasting and general catabolic state that can result in the patient's deterioration. However, the course of critical illness may be separated into 3 phases, each with highly differing metabolic needs. ⋯ Those strong enough to survive this phase enter into a period of recovery during which appetite returns, anabolism recommences, and organ function is restored. Nutrition should perhaps closely follow these nonlinear requirements, so as to avoid deleterious under- or overnutrition during the appropriate phase. This approach fits a teleologic argument that enabled many sick people to survive well before the advent of modern medicine and explains why catabolism still occurs despite adequate feeding.
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Critical care clinics · Jul 2010
ReviewFish oil in critical illness: mechanisms and clinical applications.
Fish oil is rich in omega-3 fatty acids, which have been shown to be beneficial in multiple disease states that involve an inflammatory process. It is now hypothesized that omega-3 fatty acids may decrease the inflammatory response and be beneficial in critical illness. ⋯ The results of this research to date are inconclusive for both enteral and parenteral omega-3 fatty acid administration. More research is required before definitive recommendations can be made on fish oil supplementation in critical illness.