Critical care clinics
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As previously discussed, the majority of injury cases do not necessarily involve dramatic life-saving actions, but rather very rudimentary, promptly applied precautions. For most victims of trauma, therefore, we offer reassurance and simple compassion in their time of need. One of the more important lessons to be learned here is that, beyond prehospital injury "management" or "treatment," we should always remember to provide the best possible prehospital injury care. ⋯ Successful transport of disaster victims, whether in the prehospital phase or during interhospital transfer, requires careful attention to treatment priorities, such as simple measures for airway control and ventilation, and care to prevent further injuries by appropriate immobilization techniques. The use of fully equipped teams of multidisciplinary critical care specialists in mass disaster situations is in its infancy. It is clear that with properly adapted hardware and personnel trained to function in adverse environments while effectively delivering intensive care to a large number of patients with a variety of clinical syndromes, survival can be significantly increased for the most acutely ill.
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Hypoglycemia is defined as the occurrence of a wide variety of symptoms in association with a plasma glucose level of 40 mg/dL or less. The conditions associated with hypoglycemia in hospitalized patients include exogenous insulin administration, ethanol, drugs (especially chlorpropamide), renal insufficiency, liver disease, infections, total parenteral nutrition, treatment of hyperkalemia with insulin, extensive burns, neoplasia, pregnancy, and a wide variety of less common causes. Although clinical features are helpful in making a diagnosis, a significant proportion of the patients are either asymptomatic or present with symptoms of altered mental status. ⋯ A detailed history along with a physical examination and appropriate laboratory investigations usually identify the specific cause of the hypoglycemia. An episode of hypoglycemia, especially if severe, should be treated with prolonged intravenous infusion of glucose. Prompt recognition and management of hypoglycemia are necessary to prevent significant morbidity and mortality.
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Critical care clinics · Jan 1991
Review Case ReportsEndocrine crises. Hypophosphatemia and hyperphosphatemia.
Pathophysiology, clinical sequelae, and treatment for hypophosphatemia and hyperphosphatemia are discussed. Hypophosphatemia results from a variety of conditions including malnutrition, carbohydrate refeeding, acid-base disorders, and hormonal and drug effects. ⋯ Hyperphosphatemia occurs because of increased extracellular phosphate load from either endogenous or exogenous sources or from a decrease in renal phosphate excretion. Left untreated, hyperphosphatemia can result in dangerous calciumphosphate precipitation into vital organs and tissues.
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Normal water balance with strict maintenance of plasma osmolality depends on appropriate water conservation (controlled by ADH release and action) and additional water intake if required (triggered by the awareness of thirst). Central nervous system pathology (including trauma) commonly involves the hypothalamus and pituitary stalk, leading to impaired osmoreceptor function or diminished ADH production or release, resulting in diabetes insipidus (with potentially life-threatening abnormalities in fluid and electrolyte status). Assessment of the relationships between plasma and urine osmolality and plasma ADH levels will usually lead to an accurate diagnosis. Central diabetes insipidus is effectively treated with replacement of free water deficits and exogenous ADH analogues.
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Along with the development of more specific and potent immunosuppressive agents, improvements in perioperative care of the allograft recipient have made transplantation of nonrenal organs a reality and contributed greatly to overall improvements in graft and patient survival. Thorough pretransplant evaluation, intensive care therapy and monitoring (when indicated), and meticulous postoperative care are essential to a successful outcome and to minimize the occurrence of complications.