Current opinion in critical care
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Curr Opin Crit Care · Dec 2005
ReviewRisk factors for acute renal failure: inherent and modifiable risks.
Our purpose is to discuss established risk factors in the development of acute renal failure and briefly overview clinical markers and preventive measures. ⋯ There are identified risk factors of acute renal failure. Because acute renal failure is associated with a worsening outcome, particularly if occurring in critical illness and if severe enough to require renal replacement therapy, preventive measures should be part of appropriate management.
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The possibility of content-full, universal, bioethical norms is assessed. The literature brings into question a global bioethics. A salient moral and bioethical pluralism undermines the plausibility of imposing of uniform bioethical norms on critical care. Addressing the tension between the aspiration to a global bioethics and the presence of moral pluralism is timely, given the United Nations Educational, Scientific and Cultural Organization's development of universal, bioethical norms. The practice of critical care in the 21st century will be influenced by the tension between bioethical pluralism and counter-assertions on behalf of a global bioethics. ⋯ Clinicians need to appreciate the sources of moral controversy that divide them from their patients and from their colleagues and to recognize that moral and economic differences may lead to different standards of care. Taking bioethical diversity seriously supports focusing on procedural moral approaches that allow peaceable collaboration in the face of substantive moral disagreement.
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All disasters, regardless of cause, have similar medical and public health consequences. A consistent approach to disasters, based on an understanding of their common features and the response expertise they require, is becoming the accepted practice throughout the world. This strategy is called the mass casualty incident response. The complexity of today's disasters, particularly the threat of terrorism and weapons of mass destruction, has increased the need for multidisciplinary medical specialists as critical assets in disaster response. A review of the current literature emphasizes the expanding role of disaster management teams as an integral part of the mass casualty incident response. ⋯ Disaster management teams are critical to the mass casualty incident response given the complexity of today's disaster threats. Current disaster planning and response emphasizes the need for an all-hazards approach. Flexibility and mobility are the key assets required of all disaster management teams. Medical providers must respond to both these challenges if they are to be successful disaster team members.
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Curr Opin Crit Care · Dec 2005
ReviewConventional terrorist bomb incidents and the intensive care unit.
A terror bombing creates a momentary stress on acute care services, including the emergency medical system, emergency departments, and intensive care units. A knowledge of the progression of events, the anticipated volume of injured survivors, and the pattern of injuries will enable the physician in the intensive care unit to prepare the unit quickly and efficiently for the expected rush of injured survivors. ⋯ This review, based on recently published data, aims to provide the intensive care unit physician with crucial information about the anticipated progression of events, the possible numbers of patients, and the nature of their injuries after a terrorist bombing. This information should aid in rational crisis planning.
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The purpose of this review is to describe the most prevalent mechanisms of drug-induced acute kidney injury, to define the risk factors for nephrotoxicity, and to analyze the available evidence for preventive measures. ⋯ The main mechanisms of nephrotoxicity are vasoconstriction, altered intraglomerular hemodynamics, tubular cell toxicity, interstitial nephritis, crystal deposition, thrombotic microangiopathy, and osmotic nephrosis. Before prescribing a potentially nephrotoxic drug, the risk-to-benefit ratio and the availability of alternative drugs should be considered. Modifiable risk factors should be corrected. The correct drug dosage should be prescribed. Patients should be pre-hydrated and the glomerular filtration rate should be frequently monitored during the administration of a potentially nephrotoxic drug. Studies are needed to further elucidate the mechanisms of nephrotoxicity to design more-rational prevention and treatment strategies. Computer-based prescriber-order entry and an appropriately trained intensive care unit pharmacist are particularly helpful to minimize medication errors and adverse drug events.