Critical care clinics
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Critical care clinics · Apr 1996
ReviewTransesophageal echocardiographic evaluation of native valvular disease and repair.
Surgery for valvular heart disease corrects systolic or diastolic dysfunction of the mitral, aortic, or tricuspid valves. The intraoperative echocardiographic assessment of the native heart valve is aimed at defining the pathology of valve disease, determining the mechanism of valve dysfunction, and quantitating the degree (grade) of valvular stenosis or insufficiency.
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Critical care clinics · Apr 1996
ReviewIntravascular and intracardiac ultrasound: a tool of the future.
Intravascular ultrasonography has the capability to visualize the vessel wall and perivascular structures, to identify the spatial distribution and composition of atherosclerotic plaque, and to measure accurately vessel and wall dimensions. This article discusses relevant principles of instrumentation, issues pertaining to the validation and interpretation of intravascular ultrasound images, and the current and potential applications of intravascular (and intracardiac) imaging. Emphasis is placed on uses that are likely to be of interest to the critical care physician.
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Recent discussions about futility have been useful in elucidating health professionals' responsibility to communicate, to establish trust, and to collaborate with patients and families about end-of-life decisions. They have highlighted the often impersonal and fragmented care that patients receive in today's large medical centers. Futility also has been a stalking horse for the much more important and problematic issue of rationing. The latter must be discussed on its own merits, however painful that may be.
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Critical care clinics · Jan 1996
ReviewSpiritual issues and bioethics in the intensive care unit: the role of the chaplain.
This article familiarizes the reader with the contributions of a hospital chaplain regarding spiritual and ethical issues in the intensive care unit. The unique training and perspective of the hospital chaplain are reviewed to explain how the chaplain and the parish minister compare. Cases are presented to illustrate how the chaplain functions, and specific topics of concern that relate bioethical issues with spiritual issues, such as organ donation, are addressed. Faith in "miracles" is discussed within a framework for interpreting religious ideation, particularly when belief prolongs death.
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Critical care clinics · Jan 1996
Case ReportsEthical dilemmas faced by critical care nurses in clinical practice: walking the line.
The experience of the critical care nurse includes frequent ethical dilemmas, both in patient care and in professional relationships. The moral development of the critical care nurse is presented in terms of learning theory, perceptive transformation, and ethical theory as it applies to the predominantly female profession of nursing. Four case studies and verbatim accounts of the experiences of critical care nurses illustrate moral development.