Critical care clinics
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Colloid fluid solutions are frequently used as plasma volume expanders in the critically ill. As a group, these nonblood volume replacement solutions have in common a number of potential adverse effects. ⋯ Renal dysfunction has been associated with dextran 40, myocardial depression with albumin, hypotension with purified plasma protein, and hyperamylasemia with hetastarch. Because no ideal colloidal solution exists, knowledge of type, severity, and clinical significance of adverse effects is important in determining the appropriate plasma volume expander and monitoring its effects.
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Critical care clinics · Jul 1991
ReviewOpioids and other analgesics. Adverse effects in the intensive care unit.
Analgesics are an important component of care for critically ill patients. The agents available--opioids, anesthetics, and NSAIDs--are efficacious, but each is capable of inducing a variety of adverse effects. ⋯ Anesthetic agents and NSAIDs offer less effect on cardiovascular and respiratory function than opioids, but are not without adverse effects. A thorough understanding of analgesic-associated adverse effects and drug interactions, as well as methods for anticipating and monitoring them, can help to minimize their effect on the ICU patient.
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Critical care clinics · Apr 1991
ReviewClinical algorithm for initial fluid resuscitation in disasters.
This article reviews past experience with branch-chain decision trees for fluid resuscitation of various emergency conditions and analyzes the effects of compliance with the algorithm on mortality and shock-related complications. On the basis of this analysis, the authors propose a new algorithm for fluid resuscitation of mass casualties when only palpable systolic blood pressure is available and when blood pressure, hematocrit, central venous pressure, urine output, and arterial blood gases are available.
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A disaster that produces a multitude of patients may severely stress a community's health-care system, from the EMS system to the hospitals. Physicians involved in such an event must realize that they will have to change their normal mode of delivering care, having to make decisions with less than the normal amount of information, and doing the most good for the most salvageable patients. Some understanding of and appreciation for the unique problems that face emergency personnel in the field are important for physicians who do not normally interact with fire and EMS personnel, because it will allow them to realize that they are not alone in the chaos of a disaster. ⋯ Hospital physicians can do much to prepare themselves for these eventualities. Discussion and planning should be done among separate staffs (ICU, operating suite, emergency department), as well as among staff of the various disciplines so they can interact more effectively when a disaster occurs. Local disaster planners should receive input from hospital staffs so hospital capabilities are known and the field operation can mesh well with the hospital's operation.
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Critical care clinics · Apr 1991
Evaluation of a blunt and penetrating trauma algorithm for truncal injury.
The authors objective was to develop and test a single branch-chain decision tree for blunt and penetrating truncal injury. Over the 4-month study period there were 979 patients evaluated in the emergency department; 674 of these patients were admitted to the hospital. Thirty-four (5%) of the 674 admitted patients died of truncal injury. ⋯ Of the 44 patients managed with major deviations from the algorithm, 27 (61%) died. Only 14 of the 195 patients (7%) whose management complied with the algorithm died. The authors conclude that following the specific management criteria outlined by the algorithm may improve the survival of severely traumatized patients.