Journal of intensive care medicine
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J Intensive Care Med · Jan 1995
ReviewTreatment of hypothermia in trauma victims: thermodynamic considerations.
The relatively high specific heat of the human body makes hypothermia very difficult to treat. Although there are many treatment methods available, most evaluations of rewarming techniques are based on clinically observed rewarming rates, and they do not take into account initial core temperature, ambient temperature, the patient's own heat production, the effects of anesthesia, paralytic agents, and other variables. ⋯ A commercially available routine is used to solve the equations, which also include any heat exchange between the patient's body and the environment, as well as metabolic heat generation as a function of time and core temperature. This thermodynamic analysis of rewarming, based on computer modeling of heat transfer, provides a scientific basis on which to establish guidelines for appropriate selection of treatment strategies for hypothermia, and it indicates that direct blood warming or infusion of warm intravenous fluids are the most effective rewarming techniques.
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J Intensive Care Med · Sep 1994
ReviewTrauma radiology: part III. Diagnostic and therapeutic angiography in trauma.
Angiography has a central role in both diagnosis and therapy of traumatic vascular injuries from blunt and penetrating mechanisms. Angiography is considered the "gold standard" for establishing the presence of vascular injury, but precise indications and appropriate timing of angiography in certain clinical situations, such as proximity injury to the extremities or penetrating neck injuries, remain controversial. We consider the role of angiography in the diagnosis of major arterial injury in the thorax, selective use of diagnostic and therapeutic angiography for intraabdominal trauma, identification and control of pelvic hemorrhage, and detection of vascular injury of the head, neck, and extremities.
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J Intensive Care Med · Jul 1994
ReviewTrauma radiology: part II. Diagnostic imaging of thoracic trauma: review and update.
Frontal chest radiographs are the principal diagnostic imaging study to detect, verify, or exclude acute thoracic injury after trauma, and they should be obtained as quickly as possible without compromising clinical assessment and resuscitation. Chest radiographs provide important information about potentially life-threatening conditions, such as tension pneumothorax, major hemothorax, and major arterial injury. ⋯ On occasion, magnetic resonance imaging can be used to assess integrity of the hemidiaphragms and visceral herniation when other diagnostic studies are equivocal. We consider typical imaging findings associated with a variety of acute thoracic injuries, as well as the most appropriate use of available imaging techniques in different clinical scenarios.
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J Intensive Care Med · Nov 1992
Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group.
Using the medical literature to solve patient problems is challenging and rewarding. For intensive care physicians, this evidence-based medicine approach is more compelling when basic critical appraisal skills are developed. We highlight the important methodological points for interpreting the literature on treatment, using a cogent example from the critical care literature--monoclonal antibody therapy in sepsis. It is likely that as we move into the 1990s, growth in the number of articles on immunotherapy in the sepsis syndrome will parallel the growth of the general biomedical literature.
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J Intensive Care Med · Nov 1992
ReviewIndications, technical considerations, and strategies for renal replacement therapy in the intensive care unit.
Renal replacement therapy in the intensive care unit can vary from simple procedures to very complex technologies. I discuss the factors that contribute to the decisions regarding the selection of a specific therapy. These factors include immediate and intermediate therapeutic goals (e.g., solute removal, dehydration), hemodynamic stability and other clinical conditions, and the technical requirements obligate to specific therapies. The differences between convective and diffusive solute removal are described, as well as the rationale for choosing one over the other. This choice is particularly relevant to and dependent on the therapeutic goal. Spontaneous blood flow versus pumped blood flow is debated. Lastly, the removal of middle molecular weight molecules is discussed in the context of toxic cytokines or bacterial products.