Critical care clinics
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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.
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This article reviews the cardiac sequelae of blunt chest injury. Major cardiac injuries of blunt chest trauma involve damage to the myocardium, although pericardial disease, valvular heart disease, and coronary artery disease may result. Recognition of the various syndromes associated is discussed, and a synthesis of diagnostic and management strategies for speculation is provided.
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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.
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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.
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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.