Articles: critical-care.
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Pediatr. Clin. North Am. · Apr 1993
ReviewTransport management of the patient with acute poisoning.
Poisoning in children is a common clinical problem encountered by pediatricians, general practitioners, and emergency room physicians. Poisoning in children less than 5 years of age is usually accidental, whereas, in young adults, any disparity between expected history and clinical findings should suggest poisoning. It is imperative that the treating physician expeditiously recognize, begin treating, and plan to transfer, when indicated, by specialized pediatric transport team the critically ill poisoned child to a tertiary care facility.
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Critical care medicine · Apr 1993
Review Practice Guideline GuidelineA model for technology assessment applied to pulse oximetry. The Technology Assessment Task Force of the Society of Critical Care Medicine.
To test a model for the assessment of critical care technology. To develop practice guidelines for the use of pulse oximetry. ⋯ The model developed for technology assessment proved to be appropriate for assessing pulse oximetry. The available data have allowed us to develop an evidence-based practice policy for the use of pulse oximetry in critical care. Critical care clinicians, researchers, and industry have a shared responsibility to provide valid outcome and efficacy studies of new technologies.
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Appropriate airway management is essential for the successful transport of sick children. Airway management begins with a thorough history and physical examination and may proceed to invasive therapeutic interventions. Successful care of the pediatric airway can be achieved only with a thorough knowledge of airway management technique and equipment. In addition, familiarity and understanding of the pharmacologic adjuvants to airway management and sedation will help to achieve the primary objective of any transport team, namely a safe and smooth transport of the critically ill child.
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Critical care clinics · Apr 1993
ReviewMetabolic and nutritional support of the intensive care patient. Ascending the learning curve.
The learning curve of nutritional support in the critically ill began with the amelioration of the effects of starvation in patients with a disabled intestine. Next, there was an appreciation that feeding formulas could be tailored to support patients with specific organ insufficiencies. Then it was realized that feeding enterally has distinct advantages over feeding parenterally. ⋯ In the future, feeding formulae will be devised that continue to modify the patient's response to illness favorably. Another important consideration is to begin nutritional support as soon as possible--i.e., on the day of admission, if appropriate. The critical care specialist should be expert in these techniques, with the goal of eliminating malnutrition as a confounding variable in the clinical course of the intensive care unit patient.
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The purpose of this article is to review the facilities of early enteral nutrition in critically ill patients. ⋯ Clinical performance as well as efficiency of enteral nutrition seem to be essentially dependent on the intestinal blood flow. New methods for estimating intestinal blood flow, such as tonometry, will have to be evaluated especially in critically ill patients to improve the indications for enteral nutrition.