Critical care medicine
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Critical care medicine · Feb 1994
Changing patterns of terminal care management in an intensive care unit.
To empirically describe changes in terminal care management behavior over time with the advent of natural death acts and public dialogue and institutional policy regarding terminal care. ⋯ There is now an increasing probability that impending death will be acknowledged by a formal terminal care decision. Such decisions may become even more frequent with the dialogue generated by the Patient Self Determination Act and the advent of decisions based on physiologic futility.
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Critical care medicine · Feb 1994
Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event.
To determine: a) the frequency of premonitory signs and symptoms before cardiac arrest in patients on the general medical wards of a hospital; b) any characteristic patterns in nurse and physician responses to these signs and symptoms; and c) whether cardiac arrests on the ward occur more frequently in patients discharged from the medical intensive care unit (ICU) than in other patients. ⋯ Cardiac arrests on the general wards of the hospital are commonly preceded by premonitory signs and symptoms. Strategies to prevent cardiac arrest should include training for nurses and physicians that concentrates on cardiopulmonary stabilization and how to respond to neurologic and respiratory deterioration. Special attention should also be devoted to patients who have been discharged from the ICU who are at greater risk for cardiac arrest after ICU discharge than are other medical patients.
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Critical care medicine · Feb 1994
Attitudes of critical care medicine professionals concerning distribution of intensive care resources. The Society of Critical Care Medicine Ethics Committee.
To determine critical care practitioners' attitudes about the importance of various factors in decisions to use intensive care, including age, prognosis, quality of life, patient preference, and medical condition. ⋯ These results suggest that critical care providers, who must occasionally face difficult decisions about how to distribute limited resources among patients with competing needs, were not often inclined, at the time of this survey, to make choices based on estimates of who might benefit most. These critical care physicians' attitudes about triage may not support the optimal use of critical care resources.
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Critical care medicine · Jan 1994
Pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for intensive care or major interventions during interhospital transport.
To test the hypothesis that a pretransport Pediatric Risk of Mortality (PRISM) score underestimates the requirement for both intensive care and interventions during pediatric interhospital transport. ⋯ PRISM scores determined before interhospital transfer of pediatric patients underestimated the requirement for intensive care and the performance of major interventions in the pretransport setting. Many patients with low PRISM scores required intensive care on admission to the receiving hospital and major interventions during the transport process, and, therefore, were not at "low risk" for clinical deterioration. The PRISM score should not be used as a severity of illness measure or triage tool for pediatric interhospital transport.
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Critical care medicine · Jan 1994
Editorial Comment Comparative StudyPressure-limited versus volume-cycled breath delivery strategies.