Critical care clinics
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Critical care clinics · Jul 2001
ReviewAcute respiratory failure in critically ill patients with cancer. Diagnosis and management.
Respiratory failure remains a common cause of admission to the ICU for patients with cancer, regardless of the nature of malignancy. The diagnosis and management of ARF in patients with cancer poses special challenges to the intensivist. ⋯ Severity-of-illness scoring systems and mortality probability models, although useful in discriminating between survivors and nonsurvivors in large groups of critically ill patients, should not be used alone to justify reluctance in admitting individual patients with cancer with potentially reversible respiratory failure to the ICU. Close collaboration between oncologists and intensivists will ensure the establishment of clear goals and direction of treatment for every patient with cancer who requires mechanical ventilation.
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Patients with cancer are at risk for developing a variety of fluid and electrolyte disturbances caused by the disease process or by complications from therapy. An understanding of the pathophysiology of these potential abnormalities allows the clinician to manage patients expectantly and to avoid severe metabolic disarray by correcting imbalances promptly.
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Caring for a critically ill patient with cancer requires another dimension of care when compared with caring for patients in a general ICU. The oncology critical care staff deals with an acute event and with the multidimensional aspects of care of a patient with a cancer diagnosis. ⋯ Effective management requires a multidisciplinary approach to care. Skilled and knowledgeable care and communication among all members of the team are essential to prevent, minimize, and treat these symptoms and to achieve optimal patient outcomes.
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Significant advances have been made in the management of cardiac arrhythmias. New technology has enhanced the ability to understand and treat a variety of tachycardias. ⋯ A new indication for cardiac pacing is evolving as a supplemental treatment for patients with refractory congestive heart failure. These and other advances provide numerous exciting options for management of cardiac patients.
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Antiplatelet therapy with aspirin has long been established as standard therapy in the management of conditions such as ST-elevation myocardial infarction and the acute coronary syndromes (unstable angina and non-ST-elevation myocardial infarction). Recently, several more potent platelet inhibitors have been developed and tested in randomized clinical trials. This article reviews the current state of the art of antiplatelet therapy.