Critical care clinics
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In summary, the incidence of BCI following blunt thoracic trauma patients has been reported between 20% and 76%, and no gold standard exists to diagnose BCI. Diagnostic tests should be limited to identify those patients who are at risk of developing cardiac complications as a result of BCI. Therapeutic interventions should be directed to treat the complications of BCI. Finally, the prognosis and outcome of BCI patients is encouraging
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Critical care clinics · Jan 2004
ReviewInitial management of pelvic and femoral fractures in the multiply injured patient.
The management of polytrauma patients is clinically challenging and requires a multi-disciplinary team approach. The immediate and definitive operative care of fractures represents the optimal treatment for polytrauma patients with orthopedic injuries. Early orthopedic intervention in long bone fractures and pelvic ring injuries has been shown to decrease pulmonary complications, improve hemodynamic stability, reduce ventilator time, and facilitate early patient mobilization. These factors decrease mortality and improve outcomes for patients with multiple injuries.
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For both SCI and TBI, physicians are unable to affect reversal of the cellular injuries suffered at the time of trauma directly. Unfortunately, understanding such processes is just on the horizon. ⋯ Aggressive and pre-emptive attention to the ABC(D)s with attention to the needs of the injured nervous system, appropriate monitoring in all patients, meticulous medical management, and prompt surgical intervention when indicated have made marked improvements in outcome, particularly in TBI. Focusing on the basics and strict attention to detail appear to be the major roles played in the care of CNS trauma.
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Surgical procedures on geriatric patients are not always benign, but postoperative mortality and morbidity is improving. Optimal care depends on our ability to recognize potential risk factors and intervene in a positive manner. Not all the data are complete, and we are missing several key randomized trials, but investigators have identified many areas for possible intervention. Hopefully, in the near future, more concrete recommendations can be given for this very large and important topic of perioperative anesthetic issues in the elderly.
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As the number of elderly patients receiving oncologic therapies increases, the need for better outcome predictors for the critically ill elderly with cancer increases. Physicians should not view age as an indicator of poor ICU outcome, as many elderly patients with cancer will derive the same benefit from intensive care as their younger counterparts. ⋯ These parameters, in addition to clinical judgment, can be helpful in deciding who will benefit from ICU care regardless of age. Oncologists and critical care physicians will need to collaborate and change the paradigm of ICU care for the elderly.