Articles: intensive-care-units.
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By applying a sensible toxicological approach to the general principles of intensive care, an optimum setting for the treatment of poisoning is created. The intensive care unit (ICU) can perform the necessary close observation and monitoring, and thus facilitate rapid detection of symptoms, and the institution of early appropriate treatment. Diagnosis may be complex in poisoning and require continuous qualified interpretation of clinical and analytical data. ⋯ The capacity of the ICU to counteract various toxic effects in a nonspecific way and to provide optimum symptomatic and supportive care is crucial. However, the ongoing toxic effects on the body must always be considered and allowed to guide symptomatic treatment. Thus, clinical toxicology appears to be a specialised branch of intensive care medicine.
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An optimal outcome for a distressed newborn infant can be achieved only if immediate resuscitation is followed by appropriate cardiopulmonary intensive care. In the preceding article in this series, we provided recommendations for drug therapy during the initial resuscitation. When an infant is stable enough for transfer to an intensive care nursery, extended cardiopulmonary intensive care should be initiated. ⋯ Drugs that alter the distribution of the circulation may be required for infants with persistent hypoxemia due to pulmonary hypertension or congenital heart disease (tolazoline, nitroprusside, prostaglandin E(1)), or with pulmonary congestion due to persistent patency of the ductus arteriosus (indomethacin). Infants with pulmonary disease may benefit from administration of agents that alter pulmonary function (furosemide, nitroprusside or neuromuscular blockers). Finally, treatment of the underlying disorder, with antibiotics or naloxone, for example, must not be neglected.