Articles: patients.
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To report Palmerston North Hospital's (PNH) recent experiences with paediatric admissions to the general Intensive Care Unit (ICU), and to identify any aspects relevant to regionalisation of paediatric intensive care. ⋯ If the PNH experience reflects that of other similar institutions, then non-tertiary ICUs admit small numbers of critically ill paediatric patients who tend to be of low to moderate severity, but who cover the full spectrum of severity. Most cases can be well managed locally, but appropriate referral and transfer is an important component in the delivery of a rational and integrated paediatric intensive care service.
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To review the current status of echocardiography in critically ill patients with special reference to the advantages and disadvantages of the transthoracic and transoesophageal approaches. ⋯ Echocardiography often provides useful information in critically ill patients. Intensivists should familiarise themselves with this new technology and if possible become skilled practitioners of this exciting technique. The care of critically ill patients will benefit from its widespread use.
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To review the pharmacodynamic and pharmacokinetic properties of digoxin in health and disease and the potential use and toxic effects of digoxin in the critically ill patient. ⋯ Digoxin is a therapeutic agent with unique effects. It should be considered in all patients with systolic heart failure, supraventricular tachycardia, and, in association with other treatment, as a single dose of 750 -1000 mug/70 kg in patients not treated previously with digoxin who have septic shock. It should be avoided in patients with critical coronary artery disease and ischaemic or hypertrophic diastolic failure.
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To review the pathophysiology and management of patients with clinical manifestations of fat embolism. ⋯ Fat embolism occurs in many traumatic and atraumatic conditions and is largely asymptomatic. Preventative measures include early immobilization of fractures and methods to reduce intramedullary pressure during surgical manoeuvres. Treatment is largely symptomatic with therapy for respiratory failure similar to that used in management of acute respiratory distress syndrome. Corticosteroids have not been found to be of significant benefit.