Articles: critical-care.
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Wien. Klin. Wochenschr. · Jan 1994
Review["Small volume resuscitation"--does it open new possibilities in the treatment of hypovolemic shock?].
Hypertonic-hyperoncotic solutions are a supplementation to conventional fluid regimens in the management of hypovolemia due to trauma, hemorrhage and shock. In this review the possible modes of action of these solutions are discussed and their efficacy both in experimental and clinical settings is presented. Possible side effects, such as hypernatremia and possible problems in the presence of increased intracranial pressure, following administration of hypertonic-hyperoncotic solutions are discussed, as well as the reaction of normovolemic patients to such infusions.
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Little research was found to indicate that pain is managed well in hospitalized patients and few studies were found regarding pain management for critical care patients. ⋯ Results from this study suggest that nurses in both intensive care and surgical units do not appropriately assess, manage or evaluate pain and pain-related side effects. Patients who experience pain expect to have their pain controlled. Efforts must be made to change nurses' pain management behaviors.
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The indications for the use of mechanical cardiac assist-devices are sudden death, cardiogenic shock, severe coronary ischemia and high-risk PTCA. Among the cardiac assist-devices, currently available for cardiologists and cardiac surgeons, are the Intraaortal Balloon Pump (IABP), the implantable turbine-pump, the percutaneous cardiopulmonary support (PCPS), centrifugal pumps which are connected via a thoracotomy and intra- and extrathoracic total artificial hearts. It is easy to position the IABP, which can be continuously used over the course of several days. ⋯ In therapy-resistant circulatory arrest, approximately 30% of patients could be saved with this system, provided that there is a very quick access to it, as there is for example in the cardiac cath lab. Centrifugal pumps, which are inserted via a thoracotomy, and artificial hearts have become very important and are now used routinely in cardiac surgery to support patients, who have developed therapy-refractory heart failure, and in transplantation-surgery as "bridging to transplant". These systems, however, bear the complications of hemorrhage and thromboembolism.(ABSTRACT TRUNCATED AT 400 WORDS)