The Surgical clinics of North America
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Surg. Clin. North Am. · Jun 2000
ReviewUltrasound and other imaging technologies in the intensive care unit.
As technology advances, more imaging and procedures are performed at the bedside on critically ill patients in ICUs, thereby eliminating the risks of transporting patients. These imaging techniques can serve as diagnostic and therapeutic tools in treating the acute and chronic consequences of injured, critically ill patients. One area of growth is ultrasonography. ⋯ Images are now becoming readily and easily available with the advancement of teleradiology. Some of the imaging modalities are still in development, and their clinical effectiveness is being studied. In the future, more uses of these various imaging technologies may become evident and cost-effective.
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Surg. Clin. North Am. · Jun 2000
Review Case ReportsTermination of life support after major trauma.
As the population continues to age, greater numbers and more severely injured elderly patients require care in ICUs. With the attendant increase in the medical complexity of such patients, investigators anticipate that trauma and critical care resources will become increasingly stretched. ⋯ The authors propose the following guidelines for discussing limitation or termination of life support with patients and their families. Physicians should (1) discuss the patient's wishes regarding life support on admission or early in the hospital course; (2) at the initial discussion, establish who the decision maker will be if the patient is or becomes incapacitated; (3) maintain regular communication and continuity of care; and (4) inevitably, when conflict occurs, involve consultants and a hospital ethics committee for assistance in its resolution.
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Surg. Clin. North Am. · Jun 2000
ReviewAnesthetics, sedatives, and paralytics. Understanding their use in the intensive care unit.
This article reviews the use of inhalational, intravenous, and epidural agents used in the operating room and ICU. An emphasis is placed on the rationale for their selection. Additionally, the side effects and expected complications are discussed. By developing expertise with one's own repertoire of sedatives, narcotics, and neuromuscular blocking agents, one may decrease postoperative complications and lengths of stay.
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The ICU plays a pivotal role in the care of the critically injured patient. From the resuscitative phase of care through the life-support phases and finally the recovery phase, advances in ICU care have been made in recent years. As a result, an improved outcome for traumatically injured patients often is seen, and the third peak in the trimodal distribution of trauma deaths has been affected significantly.