Critical care clinics
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Critical care clinics · Oct 2022
ReviewThe Next Frontier in Neurocritical Care in Resource-Constrained Settings.
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
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Critical care clinics · Oct 2022
ReviewCurrent State of Critical Care Nursing Worldwide: Current Training, Roles, Barriers, and Facilitators.
This review provides insights on the current state of roles and responsibilities, on-the-job training, barriers, and facilitators of critical care nursing (CCN) practice. Some of the established roles and training of CCN were providing care for acutely ill patients, delivering expert and specialist care, working as a part of a multidisciplinary team, monitoring, and initiating timely treatment, and providing psychosocial support and advanced system treatment, especially in high-income countries. In low-resource settings, critical care nurses work as health care assistants, technical or ancillary staff, and clinical educators; manage medications; care for mechanically ventilated patients; and provide care to deteriorating patients.
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Critical care clinics · Oct 2022
ReviewEssential Emergency and Critical Care: A Priority for Health Systems Globally.
Critical illness is a state of ill health with vital organ dysfunction, a high risk of imminent death if care is not provided, and the potential for reversibility. An estimated 45 million adults become critically ill each year. ⋯ We outline a priority for health systems globally: the first-tier care that all critically ill patients should receive in all parts of all hospitals: Essential Emergency and Critical Care. We describe its relation to other specialties and care and opportunities for implementation.
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Critical care clinics · Oct 2022
ReviewLiving on the Edge of Possibility: Ethical Issues in the Care of Critically Ill Patients in Resource-Limited Settings.
The birth, expansion, and sustenance of critical care medicine as a specialty have often presented ethical challenges and dilemmas to health care workers in diverse settings. In addition to critical services being provided at the extreme end of a disease process, they are often in limited supply. The authors present patterns of inception and development of this crucial service as they have witnessed in rural Africa. Furthermore, they present the ethical challenges, both typical and unique, as they have experienced them in a tertiary referral center in Kenya.
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Critical care clinics · Oct 2022
ReviewFocused Cardiac Ultrasound Training for Non-cardiologists: An Overview and Recommendations for a Lower Middle-Income Country.
Poor outcomes among the critically ill in low- and middle-income countries (LMICs) have been attributed in part to the challenge of diagnostic delays caused by lack of skilled personnel. Focused cardiac ultrasound (FoCUS) by non-cardiologists may mitigate the shortage of echocardiography experts to perform emergency echocardiography at the point of care in these settings. It is however crucial that FoCUS training for non-cardiologists in LMICs be based on robust evidence to support training delivery if diagnostic accuracy is to be assured.