Critical care medicine
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The most common bleeding and clotting problems in post-traumatic states are reviewed. The normal response of the coagulation system and the fibrinolytic system to trauma is described; this response must be considered when studying the abnormal situations. The laboratory tests need not be numerous or sophisticated but they must be repeated often enough to understand and interpret the data. A proper understanding of these abnormalities forms the rational basis for the correct choice of therapy, and is of utmost importance in the management of post-traumatic patients.
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The limited variation of pulmonary responses to disease--dyspnea, cough, production of adventitious sounds, sputum production, and hemoptysis--complicates the differential diagnosis of the acutely ill patient with obvious severe pulmonary disease. This paper attempts to reinforce and redefine this problem: acute cardiac and pulmonary dyspnea can generally be separated by quick but careful clinical analysis; mis-diagnosis may lead to disaster since effective treatment of one is frequently harmful to the other.
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Critical care medicine · Nov 1975
Comparative StudyThe therapeutic intervention scoring system. An application to acutely ill cancer patients.
The Therapeutic Intervention Scoring System (TISS) has been introduced (Cullen DJ, Civetta JM, Briggs BA, et al: Therapeutic intervention scoring system: A method for quantitative comparison of patient care. Crit Care Med 2:57-60, 1974) at the Massachusetts General Hospital as a means of quantifying the medical and nursing care required by critically ill patients. The method has been instituted in the Intensive Care Unit of Memorial Cancer Center to evaluate its applicability to patients who develop life-threatening complications of their disease or its treatment. ⋯ This average compares closely with that of postcardiac surgery patients (31.8 points), the group that required the most care of all patients in the initial study. The results indicate the usefulness of this sytem in evaluating severity of illness, predicting survival, and assessing cost benefits. It has proven to be a simple and accurate method of assessment when simple and accurate method of assessment when applied to this patient population, but certain modifications seem warranted and have been suggested herein.
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Nine variables were studied in 56 patients to analyze hemodynamic patterns of critically ill and shock patients. The variables were central venous pressure, mean arterial pressure, heart rate, cardiac index, left ventricular stroke work, strok index, total peripheral resistance, arteriovenous oxygen difference, and oxygen consumption. We observed six patterns; three with low cardiac index (hypodynamic) and three with high cardiac index (hyperdynamic). ⋯ Group IID: High cardiac index and increased arteriovenous oxygen difference in patients with sepsis and stable hemodynamic conditions. Groups IIE and IIF: Increased cardiac index and normal or increased arteriovenous oxygen difference in septic patients, who were hemodymamically unstable or in shock. These hemodynamic observations were found to be useful for understanding physiological compensations, for deciding on therapy, and in evaluating the effectiveness of therapy.