Critical care clinics
-
Critical care clinics · Jul 1998
ReviewAn evidence-based approach to management of increased intracranial pressure.
Current treatment of many conditions associated with elevated ICP of the brain involves stabilization and oxygenation with maintenance of adequate perfusion of cerebral tissue, while maintaining an acceptable ICP. As an example of a standard protocol that is in concordance with what is already known about a patient with a severe head injury, the first priority is radiographic screening for a surgical lesion. ⋯ Acutely elevated ICP is treated with mannitol, and if this fails, patients are routinely sedated, paralyzed, and mildly hyperventilated, while repeat radiology is obtained to rule out a further surgical lesion. Hypothermia, aggressive hyperventilation, and barbiturate coma continue to be used and are reserved for intractable ICP elevation, or as warranted based on a specific patient (Table 2).
-
Critical care unit patients show a higher risk of developing a bloodstream infection than ward patients. The urinary tract is the main source of hospital-acquired secondary bloodstream infection. Nosocomial urinary tract infection is promoted by bladder catheterization in the vast majority of cases. ⋯ Sepsis and septic shock are severe complications of these infections in the critical care patient. Management of patients with a septic process of urinary source calls for the combination of adequate life-supporting care, an appropriate antibiotic therapy, and innovative adjunctive measures. Accurate catheter care is the best measure to adopt for the prevention of urosepsis.
-
Fever in the critical care unit (CCU) may be on an infectious or noninfectious basis. Many noninfectious disorders have clinical and laboratory features mimicking infections. ⋯ Selection of appropriate antibiotic therapy is straightforward once the likely source of sepsis is determined. This article provides a clinical diagnostic approach.
-
Poisoning by drugs that block voltage-gated sodium channels produces intraventricular conduction defects, myocardial depression, bradycardia, and ventricular arrhythmias. Human and animal reports suggest that hypertonic sodium bicarbonate may be effective therapy for numerous agents possessing sodium channel blocking properties, including cocaine, quinidine, procainamide, flecainide, mexiletine, bupivacaine, and others.
-
Critical care clinics · Oct 1997
ReviewGastrointestinal decontamination after poisoning. Where is the science?
The approach to the use of gastrointestinal decontamination procedures in the treatment of ingested toxins has changed in recent years. Many toxicologists and physicians have taken strong positions either for or against the use of emesis, gastric lavage, activated charcoal, or other procedures. What is the scientific basis for these positions? This article reviews and comments on the published studies comparing the effectiveness of these widely used procedures.