Southern medical journal
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Massive transfusion, or the rapid administration of a quantity of blood products that approximates an individual's blood volume, is associated with many potentially lethal complications. If the need for transfusion is immediate, ie, before adequate typing and crossmatching procedures can be completed, O negative RBCs can be given safely in the interim. Hypothermia caused by cold banked blood is aggravated by multiple environmental factors and should be aggressively avoided through the use of heat lamps, warming coils, blankets, and other warming devices. ⋯ Citrate toxicity and hypocalcemia are usually self-limiting disturbances. Prophylactic use of calcium chloride is dangerous and unnecessary. The complexity of the conditions necessitating massive transfusion demands frequent reevaluation of multiple laboratory and clinical factors for effective resuscitation and for safe administration of blood.
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Over the past several years, there has been growth in the number of training programs in the new subspecialty of critical care medicine. The adoption of subspecialty certifying examinations in critical care medicine has added momentum to the growth of the subspecialty. A personal experience in a critical care medicine fellowship training program is detailed and contrasted with a year of clinical pulmonary fellowship training. ⋯ Technical expertise in intensive care unit procedures and therapy was stressed during the critical care medicine fellowship, whereas the year of clinical pulmonary training was of greater scope, encompassing comprehension of pulmonary pathophysiology, diagnostic procedures, and therapy. "Hands-on" intensive care unit training was limited during the pulmonary fellowship, though didactic instruction and the conceptual approach to critical illness was stronger. Research training opportunities were largely equivalent. From this experience, I present suggestions for selecting fellowship training in critical care medicine.