Critical care medicine
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Critical care medicine · Sep 1975
A system-structured medical record for intensive care patient documentation.
The problem-oriented approach to the medical record has aroused a long overdue interest in the structuring of the medical case file. Clinical information in the traditional record is source-structured and time-sequenced, whereas the problem-oriented system differs by being a problem-structured record retaining still a chronologic sequence. We have found that in acute illness the multiplicity of interacting pathophysiologic processes makes premature application of the problem-oriented approach cumbersome and unwieldy. ⋯ Some used the simple cataloguing of events and data as a substitute for clinical judgment and decision making, focusing more upon style rather than content of the medical record. By using a rigid physiologic system-structured "problem" list and a modification of the SOAP (Subjective Objective, Assessment, Plan) subdivision, we have improved the documentation of our intensive care patients. The summary of the patient's stay in the intensive care unit is structured with active and inactive problems, this summary to be further used as the permanent problem list.
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Critical care medicine · May 1975
Algorithm for resuscitation: a systematic plan for immediate care of the injured or postoperative patient.
A systematic integrated approach to the diagnostic, monitoring and fluid volume therapy was developed for use in patients with accidental and elective surgical trauma. An algorithm (patient care protocol) is proposed for expeditious resuscitation in emergency situations using: (a) BP as the criteria for initiation of rapid fluid therapy, (b) hematocrit for the choice of blood transfusion or plasma expanders, and (c) CVP, urine output, arterial pressure and wedge pressure as criteria for slowing down or stopping the rate of volume therapy. ⋯ In chaotic emergency situations, it is impossible to plan for all possible contingencies; to try to do so results in an impossibly complex and unwiedly plan. However, we believe that almost any reasonable plan is better than no plan at all.
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Critical care medicine · May 1975
Second annual SCCM lecture. The role of hemodynamic monitoring in the management of the critically ill.
Balloon flotation catheterization of the central circulation provides data which may be most meaningful and important to the management of critically ill patients. It allows the measurements of the filling pressures of the right and left ventricle as well as the cardiac output. These data combined with information concerning cardiac rhythm, heart rate, arterial pressure and other variables place the principal determinants of cardiac function at the disposal of the critical care personnel. ⋯ Others are rapidly assessing the importance of the cardiac output and other parameters of cardiac function on a semi-continuous basis. Thus, balloon flotation catheterization has allowed the application of sound physiological principles to the understanding of circulatory abnormalities characterizing important patient illnesses and provides a rational basis for the selection of therapy with objective quantitative assessment of responses. The procedures are simple: the complications rate is low, and the information provided is highly relevant to clinical practice.