Critical care clinics
-
Hypovolemic shock is the most common form of shock seen clinically and has attracted the greatest laboratory interest. It is caused by a sudden decrease in the intravascular blood volume relative to the vascular capacity, to the extent that effective tissue perfusion cannot be maintained. The authors of this article discuss the pathophysiology of hypovolemic shock, the assessment of the patient in shock, the immunologic consequences of shock, impairment of cardiac function in hypovolemic shock, and the management of hypovolemic shock.
-
Critical care clinics · Nov 1985
ReviewThe systemic septic response: multiple systems organ failure.
Sepsis, which is the host response to one or more microorganisms, is probably best understood within the concept of activator-mediator-responder. The various forms of metabolic support work in all three areas. ⋯ Appropriate nutritional support seems to have been an important factor in this reduction in mortality. There are many new areas of research that need to be evaluated, and many of these areas are now directed at regulatory aspects of the metabolic response.
-
Critical care clinics · Jul 1985
ReviewCardiopulmonary resuscitation, brain blood flow, and neurologic recovery.
A review of survival rates and neurologic outcome after cardiac resuscitation indicates the importance of rapid initiation of cardiopulmonary resuscitation (CPR) and of finding ways to further improve cerebral blood flow during CPR. Mechanisms for generating blood flow to the brain during CPR and experimental strategies for enhancing cerebral viability are discussed.
-
Monitoring modalities unique to the neurologic intensive care unit include intracranial pressure monitors and neuroelectrophysiologic monitors. Each modality fullfills criteria for accuracy, responsivity during clinical change, and stability over time for trend analysis. Intracranial pressure monitoring may be accomplished by any of three approaches--ventricular catheter, subarachnoid bolt, or epidural pressure transducer. ⋯ The technology in evoked potential and signal processed EEG monitoring will eventually reduce the size and complexity of the instrumentation, making its application routine. Intracranial pressure monitoring is already routine in many intensive care units, although its use is occasionally sporadic. We believe that application of appropriate neurologic monitors improves therapy and outcome in neurologically injured and ill patients.
-
Critical care clinics · Mar 1985
Epidemiology, classification, initial care, and administrative considerations for critically burned patients.
The care of major burn injuries is a critical care endeavor from the initial evaluation and admission until the patient is discharged from the burn intensive care unit. A thorough history and physical examination are essential and require expertise to classify each burn injury. The initial treatment of the burn must address stopping the burning process, insuring a patient airway, assessing inhalation injury, initiation of adequate fluid and electrolyte resuscitation, appropriate wound care, and institution of ancillary care, such as insertion of nasogastric tubes and urinary catheters, narcotic dosage, tetanus prophylaxis, laboratory studies, and environmental temperature control. ⋯ A well trained and experienced multidisciplinary burn team under the direction of a surgeon who specializes in burns is essential to the ultimate outcome of the seriously burned patient. Effective communication among the burn team and with the burned patients requires formal protocols for general treatment as well as dynamic individualized care based on careful comprehensive observations and monitoring. The prognosis for these critically injured and ill patients depends on attention to every detail of their care, which can only be accomplished in a sophisticated critical care atmosphere with personnel skilled in intensive care techniques.