Articles: critical-care.
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Critical care clinics · Jul 1987
ReviewCritical care management of the patient with acute spinal cord injury.
The critical care management of acute injury to the cervical spinal cord is discussed from the perspective of the pathophysiology of the injury process and its ramifications. Emphasis is placed upon resolution of cardiovascular derangements, spinal cord resuscitation, and respiratory support utilizing practical therapeutic interventions.
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The activities of a trauma service in a university hospital were analyzed to test the hypothesis that operative caseload alone does not adequately measure the trauma experience of a surgical resident. Over a 2-year period, 378 victims of major trauma (blunt in 79%) were admitted to the service. Only 41% of them required a major operation by the Trauma Service. ⋯ A trauma service in a university center manages significant numbers of patients with multisystem injuries who never undergo a general surgical procedure. This experience constitutes such an important component of surgical education in trauma that it should be recognized by agencies accrediting residents and training programs. Completion of surgical residency should also imply competence in critical care of surgical patients.
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The accuracy of creatinine clearance (CLcr) determinations obtained from urine collections of less than 24 hours duration and the cyclical variation in creatinine excretion were studied in 10 critically ill patients with trauma or postoperative complications. Data from patients who received drugs or had diseases known to influence creatinine production or interfere with assay methods were excluded. Twelve consecutive two-hour urine collections and midpoint blood samples were obtained for each patient. ⋯ Mean differences between each 2-hour interval and the 24-hour interval were not significant for the 12 collection intervals. In critically ill trauma or postsurgical patients, the 24-hour CLcr can be estimated from an 8-hour urine collection if a deviation of up to 20% from the 24-hour value is clinically acceptable. No significant cyclical variation in creatinine excretion over 24 hours was found.