The Surgical clinics of North America
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Surg. Clin. North Am. · Dec 2012
ReviewRemoving the critically ill patient from mechanical ventilation.
Weaning from mechanical ventilation is usually straightforward but is occasionally challenging. Sedation must be used at the appropriate times and with appropriate dosing. ⋯ Early tracheostomy is beneficial in traumatic brain injury patients. Noninvasive ventilation is most useful in patients with baseline obstructive sleep apnea and chronic obstructive pulmonary disease.
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Surg. Clin. North Am. · Dec 2012
ReviewOptimizing drug therapy in the surgical intensive care unit.
This article provides a review of commonly prescribed medications in the surgical ICU, focusing on sedatives, antipsychotics, neuromuscular blocking agents, cardiovascular agents, anticoagulants, and antibiotics. A brief overview of pharmacology is followed by practical considerations to aid prescribers in selecting the best therapy within a given category of drugs to optimize patient outcomes.
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Surg. Clin. North Am. · Aug 2012
Review Historical ArticleLong-range critical care evacuation and reoperative surgery.
Long-range critical care aeromedical evacuation has significantly contributed to the unprecedented survival during recent military operations. With advances in critical care, patients with increased injury severity and overall complexity are routinely evacuated while resuscitation is ongoing. Additional specialty teams now provide advanced pulmonary rescue therapies for the most critically ill patients. As part of the continuum of trauma care, an overseas fixed facility provides follow-on emergency surgical critical care to optimize patient outcomes before final evacuation to the continental United States.
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The philosophy of damage control surgery has developed tremendously over the past 10 years. It has expanded outside the original boundaries of the abdomen and has been applied to all aspects of trauma care, ranging from resuscitation to limb-threatening vascular injuries. In recent years, the US military has taken the concept to a new level by initiating a damage control approach at the point of injury and continuing it through a transcontinental health care system. This article highlights many recent advances in damage control surgery and discusses proper patient selection and the risks associated with this management strategy.
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Surg. Clin. North Am. · Aug 2012
ReviewManagement of complex extremity injuries: tourniquets, compartment syndrome detection, fasciotomy, and amputation care.
Historically, complex extremity injuries, otherwise known as mangled extremities, have been difficult management problems. This is especially true in multiply-injured patients where many priorities exist and where amputation is considered a failure of limb salvage. Over the past decade, advances in the total management of complex extremity injuries, from the placement of life-saving and limb-saving tourniquets in the prehospital setting to the advancement of prosthetics and rehabilitation months to years later, have resulted in superb functional results regardless of whether limb salvage or amputation is undertaken.