Critical care clinics
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Pregnancy-induced hypertension is a disorder of unknown etiology unique to pregnant women. Classic clinical manifestations include hypertension, proteinuria, and edema. Early recognition and proper management of this disease may serve to avoid serious maternal complications. ⋯ Advanced stages of this disease result in multi-organ system dysfunction that may be life-threatening to the mother and her fetus. Such maternal complications of PIH include severe hypertension, oliguria or anuria, HELLP syndrome, eclamptic seizures, liver rupture, pulmonary edema, cerebral edema, and abruptio placentae. A multidisciplinary approach of the critical care team often will effect a reduction in maternal morbidity and mortality.
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Maternal cardiorespiratory changes can hinder satisfactory evaluation of gravid women. Alterations in the maternal cardiorespiratory system may be further modified by pain, labor, surgery, maternal posture, and gestational age. Critical illness during pregnancy demands an aggressive multidisciplinary approach by health care professionals who are familiar with these changes. This article reviews pertinent issues that should assist physicians treating complex medical complications during pregnancy.
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Shoulder dystocia, uterine inversion, and prolapse of the umbilical cord are three uncommon complications of the intrapartum period. These complications share several common characteristics in that they are rare, difficult to predict, and can result in significant morbidity and mortality. This article describes the etiology, predisposing factors, and methods of management of these complications.
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Critical care clinics · Jul 1991
ReviewNeuromuscular blocking agents and sedative drugs. Clinical uses and toxic effects in the critical care unit.
The use of sedatives and muscle relaxants is common in the ICU. Therapeutic goals should be carefully established. Monitoring of desired effects and toxic side effects is essential to avoid preventable morbidity.
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Critical care clinics · Jul 1991
ReviewToxic effects of drugs used in the ICU. Nitroprusside, nitroglycerin, and angiotensin-converting enzyme inhibitors.
Sodium nitroprusside causes cyanide poisoning at currently recommended infusion rates. Serum thiocyanate concentrations are of no value in detecting cyanide poisoning caused by nitroprusside. Methemoglobinemia in those patients receiving intravenous nitroglycerin may seriously impair oxygen delivery and is not always accompanied by cyanosis in anemic patients. Angiotensin-converting enzyme inhibitors are responsible for a plethora of adverse effects, including renal insufficiency, hypotension, angioedema, cough, and increased insulin sensitivity.