Critical care medicine
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Emergency departments serve many functions in the current U.S. healthcare system, including initial management of patients with critical illnesses and primary care for a growing proportion of the population. Overcrowding of emergency departments is a growing problem. Delays in admitting patients to inpatient units have been reported as a contributing factor to overcrowding. To date, the effect of the critically ill patients on the emergency department has not been fully described. It was the purpose of this study to examine the incidence of critical illness in the emergency department and its total burden as reflected in emergency department length of stay. ⋯ Critically ill patients constitute an important proportion of emergency department practice and may remain in the emergency department for significant periods of time. Solutions to emergency department overcrowding may include alternatives for continuing management of critically ill patients. Given the realities of emergency department practice, emergency medicine practitioners should receive training in the continuing management of critically ill patients.
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Critical care medicine · Jul 1993
Extracorporeal membrane oxygenation for cardiac rescue in children with severe myocardial dysfunction.
To assess the experience and efficacy of extracorporeal membrane oxygenation (ECMO) for cardiac rescue in patients with presumptively lethal cardiac dysfunction at the Children's Hospital of Pittsburgh. ⋯ Patients with severe myocardial dysfunction who fail conventional therapy can be successfully supported with ECMO during the period of myocardial recovery. ECMO can also provide a viable circulatory support system in patients with prolonged cardiac arrest who fail conventional resuscitation techniques. ECMO is also an effective means of support as a mechanical bridge to heart transplantation.
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Critical care medicine · Jul 1993
Pharmacokinetics of continuous infusions of fentanyl in critically ill children.
To determine the pharmacokinetics of fentanyl when used as a long-term continuous infusion for sedation/analgesia in mechanically ventilated critically ill infants and children. ⋯ Total body clearance of fentanyl is highly variable and it should be dosed to effect. Patients seen in a pediatric ICU may require a ten-fold variability in fentanyl infusion rates to achieve similar levels of sedation.
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To determine the efficacy and safety of midazolam given as a continuous infusion in the treatment of status epilepticus in children. ⋯ Midazolam is an effective and safe drug to control refractory seizures in children with status epilepticus.
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Critical care medicine · Jul 1993
Arterial to end-tidal CO2 tension difference after bilateral lung transplantation.
To assess ventilation/perfusion mismatch with high ventilation/perfusion ratios (i.e., alveolar deadspace) and to assess capnography as a noninvasive method of monitoring ventilation after bilateral lung transplantation. ⋯ Our data suggest marked alveolar deadspace ventilation immediately after bilateral lung transplantation. The presence and rapid improvement of this ventilation/perfusion mismatch may reflect the presence of ischemia-reperfusion lung injury and its improvement in the first hours of reperfusion. In five of seven patients, capnography was not a good measure of PaCO2 during the first hours after bilateral lung transplantation.