Articles: critical-care.
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The demand for medical services such as critical care is likely to often exceed supply. In the setting of these constraining conditions, institutions and individual providers of critical care must use some moral framework for distributing the available resources efficiently and equitably. ⋯ Patients who are not expected to benefit from intensive care, such as those with imminently fatal illnesses or permanent unconsciousness, should not be placed in the intensive care unit. Hospitals should assign individuals the responsibility of intensive care triage, and a committee should oversee the performance of this responsibility to facilitate the most efficient and equitable use of intensive care.
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A variety of different scoring systems are in current use, with an increasing impact on intensive care treatment. Originally these scoring systems were applied to evaluate objective grading and to estimate survival and mortality. More recently, other potential applications have been investigated. ⋯ Although desirable, individual patient prediction is therefore not allowed, and therapeutic strategies and therapy evaluation based on scoring systems cannot be implemented, or only in a limited way. For daily use in individual patient evaluation--monitoring, therapy response, prognosis--biochemical monitoring is still of primary importance. Scoring systems have now found a useful application as a supplement, rather than a rival, to clinical patient evaluation.
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Nuclear medicine techniques yield unique physiologic information about many organ systems. These types of studies can be extremely useful in the acutely ill patient. Pulmonary scintigraphy is the procedure of choice for screening dyspneic patients for pulmonary emboli. Hepatobiliary scintigraphy has a definite role in the evaluation of patients with abdominal pain and those with postbiliary tract surgical complications.
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Critical care clinics · Apr 1994
Review Comparative StudyComputed tomography of the abdomen in the critically ill.
In one's attempt to arrive at the most accurate diagnosis in the critically ill, the selection of the most efficacious and rapid imaging modality can be problematic to clinicians, especially if the clinical presentation is confusing. The selection most often, is between US and CT. In general, US is advantageous in that it can be performed at bedside and is a faster and less costly examination. ⋯ This can be accomplished best by direct communication between clinicians and radiologists before and after the examination. Radiologists who understand the clinical problems and are familiar with all diagnostic modalities should be consulted for the selection of the modality best suited to answering the question at hand. Similarly, critically ill patients should benefit most if clinicians and radiologists review the examination results together in light of the clinical presentation for more accurate and meaningful diagnosis.
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The plain film of the abdomen usually is the first radiographic examination ordered to evaluate the abdomen in the ICU patient. It is inexpensive, universally available and may be done at the bedside in the ICU. This article details and describes what to look for when interpreting a plain radiograph of the abdomen.