Critical care clinics
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Critical care clinics · Jan 1990
ReviewMilitary medicine: trauma anesthesia and critical care on the battlefield.
This article presents a few of the basic guidelines that must be considered once a decision is made to provide anesthesia and advanced surgical care in the battlefield--or in civilian catastrophes (for example, terrorist incidents, and man-made or natural disasters) that resemble the battlefield. However, it must be stressed that the most central consideration in battlefield anesthesia is the selection, training, and experience of the battlefield anesthesiologist. There are strict guidelines for providing safe anesthesia under the dire circumstances of war or similar civilian circumstances; the properly trained and experienced TA/CCS, however, will be best able to deliver battlefield anesthesia and to improvise equipment and agents for its safest delivery in those circumstances.
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Acute traumatic brain injury is a leading cause of morbidity and mortality. Intensive management is aimed at early evacuation of intracranial mass lesions, control of intracranial hypertension, and prevention of medical complications.
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Critical care clinics · Jul 1989
ReviewMultiple systems organ failure (MSOF): lessons learned from the adult respiratory distress syndrome (ARDS).
The relationship between ARDS and MSOF is explored. Models include that ARDS represents only one organ failing in MSOF, or that MSOF is a complication of ARDS owing to the development of infection and sepsis syndrome in these patients. Data are reviewed suggesting an important role of infection and sepsis syndrome in both models.
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Critical care clinics · Jul 1989
ReviewPericarditis, pericardial effusion, cardiac tamponade, and constriction.
Critical care aspects of pericardial disease are covered, including diagnosis and differential diagnosis of acute pericarditis, pericardial effusion with and without cardiac tamponade, constrictive pericarditis and effusive-constrictive pericarditis. Emphasis is placed on clinical signs and the important invasive and noninvasive diagnostic procedures, particularly various imaging methods (emphasis on echocardiography), electrocardiography, and cardiac catheterization. Medical and surgical therapies are reviewed, and the technique of pericardiocentesis is presented.
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Cardiac surgical emergencies are broken down into three categories: cardiac trauma, aortic dissection, and surgery for acute myocardial infarctions. Emphasis is given to describing the presentation of patients with such problems, and to the salient aspects of the clinical strategies for managing each problem. An important goal of each section is focusing the critical care physician on the early recognition of cardiac surgical emergencies and providing him with some rationale for instituting an expeditious plan of therapy.