Articles: critical-care.
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Critical care clinics · Jan 1990
ReviewGeneral anesthesia: management considerations in the trauma patient.
Endotracheal intubation and mechanical ventilation are vital components of the resuscitation of the most seriously injured patients and those suffering from multisystem trauma. Therefore, general anesthesia administered both intravenously and endotracheally becomes the anesthetic of choice for most of this patient population. ⋯ Monitoring techniques include the basic noninvasive monitoring set forth in the American Society of Anesthesiologist's standards, as well as invasive cardiac monitoring via arterial catheters and pulmonary artery catheters. Attention to detail in the recovery room will continue the success of a well-conducted general anesthetic for the trauma patient.
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The differential roles of infection as a microbial phenomenon and sepsis as a host response were studied in 210 critically ill surgical patients. Infections occurred in 41.4% of all cases and in 82% of nonsurviving patients. Both infection and the expression of a septic response, measured as a sepsis score, were associated with significantly increased intensive care unit morbidity and mortality. ⋯ Nonsurvivors with sepsis, on the other hand, did not differ from survivors with respect to any variable reflecting infection but did have higher mean sepsis scores. Maximum sepsis scores and sepsis scores on the day of death were similar in patients dying without infection and those dying with uncontrolled infection. The magnitude of the host septic response, independent of the presence, bacteriologic characteristics, or control of infection, is an important determinant of outcome in critical surgical illness.
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Anaesthesiol Reanim · Jan 1990
[Organization of courses in further education and continuing education as a means of ensuring quality standards].
Based on the "Standards of Postgraduate Specialisation in Anaesthesiology and Intensive Care Medicine" in the GDR, pedagogic and didactic aspects of training are presented. The learning process, the methods of teaching and the consolidation of knowledge are discussed.
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Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir · Jan 1990
[Postoperative lung complications--introduction].
Intensive care patients suffer according to literature in 20-60% from pneumonia with a mortality up to 80%. The patient, operation and postoperative therapy influence its pathogenesis. ⋯ Specifity of clinical and plain X-ray diagnosis is only 30-50%. Selective gastrointestinal decontamination, exactly monitored fluid balance, and physio-, and paintherapy seem to be valuable preventive measures.
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Critical care clinics · Jan 1990
ReviewMilitary medicine: trauma anesthesia and critical care on the battlefield.
This article presents a few of the basic guidelines that must be considered once a decision is made to provide anesthesia and advanced surgical care in the battlefield--or in civilian catastrophes (for example, terrorist incidents, and man-made or natural disasters) that resemble the battlefield. However, it must be stressed that the most central consideration in battlefield anesthesia is the selection, training, and experience of the battlefield anesthesiologist. There are strict guidelines for providing safe anesthesia under the dire circumstances of war or similar civilian circumstances; the properly trained and experienced TA/CCS, however, will be best able to deliver battlefield anesthesia and to improvise equipment and agents for its safest delivery in those circumstances.