Articles: critical-care.
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Few data exist regarding the management of severe head injury in non-neurosurgical centres within the UK. We aimed to discover the number of intensive care units admitting head injury patients, the number of patients admitted annually, and the monitoring and treatment methods followed. Questionnaires were sent to the senior nurse and consultant in 263 intensive care units within non-neurosurgical hospitals. ⋯ Intracranial pressure monitoring is routine in only 9% of units and 7% are without 24-h facilities for CT, a cause for concern. More encouragingly, 63% of hospitals have access to rehabilitation facilities. Distribution of guidelines to all intensive care units participating in the care of head injury may improve management and outcome.
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In the Intensive Care Unit important decisions in critically ill and often incompetent patients have to be made within a short period of time and without all the necessary information. Two main questions arise: 1. How can the autonomy of the patients be respected under these circumstances? 2. Which diagnostic and therapeutic activities are adequate and reasonable in each individual patient? An optimal communication between the people involved helps to find the best answers.
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Int Anesthesiol Clin · Jan 1998
ReviewThe laryngeal mask airway in emergency medicine, neonatal resuscitation, and intensive care medicine.
In assessing the potential role of the LMA outside the operating room, the risks of a less secure airway must be balanced against the benefits of ease of training, success and speed of insertion, no need for direct visualization of laryngeal structures, and lesser need for ancillary equipment. The LMA has a role as an alternative to FMV in CPR when personnel skilled in tracheal intubation are not available. ⋯ The LMA is incorporated into advanced life support training and as such should be regarded as a device providing temporary airway support, rather than a replacement for a tracheal tube. The LMA, and possibly also the ILM, should be standard equipment carried by prehospital trauma teams and by all those attending victims in the field.
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Review
Therapeutic considerations in the management of agitated or delirious critically ill patients.
Agitation and delirium in the critical care unit are common problems that at times are difficult to treat. The difficulty stems from few placebo-controlled or even blinded trials evaluating various therapies. ⋯ Pharmacologic and nonpharmacologic techniques may achieve the therapeutic objective for these patients. Since no one drug will achieve the goals in every patient, therapy must be tailored to the characteristics and needs of each individual.