Critical care clinics
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It is as important to monitor the passage of time in the resuscitation effort as it is to follow the physiologic parameters. The goals in resuscitation are based on restoring cellular metabolism to a level consistent with optimum survival. ⋯ The conduct of a resuscitation must constantly be reassessed in the light of the patient's response to the previous intervention. This response can only adequately be gauged by continual physiologic data gathering with calculation of all relevant derived data and their display in a logical, orderly, and digestible fashion--preferably with the help of a computer.
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Critical care clinics · Apr 1992
Review Case ReportsAlbumin and colloid osmotic pressure implications for fluid resuscitation.
This article reviews basic physiologic principles governing fluids in spaces. Starling's law is presented, and its interpolation into a dynamic clinical setting is discussed. These principles are further described through a case presentation.
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Fluid administration in critically ill individuals is frequently a major component of their therapy. There are important effects on blood pressure and maintenance of cardiac output and oxygen delivery, as detailed elsewhere in this text. There are also potentially negative side effects of this therapy, which have been less well defined. ⋯ Care needs to be taken in interpreting any alteration in organ function with respect to the fluid type and volume being administered. An alternative choice of therapy is lacking at present. The role of colloid has not been as well investigated as that of crystalloid and further study is warranted before any benefits become clear.
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Pain in critically ill and injured pediatric patients may go unrecognized and undertreated since children often suffer silently and caretakers are often fearful to intervene aggressively to alleviate pain. Methods are now readily available to relieve pain in the vast majority of ICU patients. ⋯ This can be achieved by the use of continuous intravenous infusions of opioids, PCA, or epidural administration of local anesthetics or opioids. Flexibility is essential so that the appropriate technique or agent can be selected for a particular pediatric ICU patient.
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The pathophysiology and clinical management of acute brain injury in infancy and childhood are presented using acute traumatic brain injury as a model. The principles of stabilization, transport, and intensive care management are critically reviewed.