Current opinion in critical care
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The prehospital care of injured patients has been surrounded with much controversy over the years. This controversy exists regarding the specific interventions used on-scene and en-route to definitive care centers, regarding the overall approach to the care of these patients (advanced life support versus basic life support) and with regards to who should be providing this care. This section of the journal aims to review the most current literature concerning these topics as well as highlight some important and relevant literature preceding it. ⋯ There is no convincing evidence that prehospital advanced life support in the urban setting provides any benefit to injured patients in terms of either morbidity or mortality.
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Curr Opin Crit Care · Dec 2007
ReviewHow safe is my intensive care unit? An overview of error causation and prevention.
To link generic research on patient safety and the reliability of care to the specific context of the critically ill patient and the environment of the intensive care unit. ⋯ Patient safety initiatives, clinical care and medical education need to be better integrated to follow the continuum of the acutely ill patient's journey through the hospital system. Key elements include improving the reliability and standardization of processes of care, reducing unnecessary variation and complexity, and encouraging teamworking.
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This article reviews new aspects about the significance, diagnosis and treatment of different chest injuries. ⋯ Faster and more detailed diagnosis of thoracic injuries has been achieved by multislice computed tomography. The modern management of thoracic injuries is complex. Minimally invasive techniques (thoracoscopic surgery, endovascular repair) and recent developments in lung supportive therapies reduce mortality and morbidity. However, emergency thoracotomy is still an important and valuable approach for life-saving or damage-control procedures.
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Poor communication in critical care teams has been frequently shown as a contributing factor to adverse events. There is now a strong emphasis on identifying the communication skills that can contribute to, or protect against, preventable medical errors. This review considers communication research recently conducted in the intensive care unit and other acute domains. ⋯ Critical care teams perform many activities where effective communication is crucial for ensuring patient safety and reducing susceptibility to error. To develop valid team training and assessment tools for improving teamwork in the intensive care unit there is a requirement to better understand and identify the specific communication skills important for safety during the provision of intensive care medicine.