Articles: critical-care.
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Critical care medicine · Dec 1984
Availability of critical care personnel, facilities, and services in the United States.
This survey of 1474 special care units in the United States found that smaller hospitals tended to have only one ICU. The number of ICUs increased with overall hospital size; when a hospital had two ICUs, the second unit was usually for coronary care. Internists directed most of the ICUs, followed in decreasing order by surgeons, family practitioners, anesthesiologists, and pediatricians. ⋯ The number of house officers varied widely according to hospital size, as did the numbers of subspecialty fellows and nonphysician professional and paraprofessional personnel. The availability of services in hospitals also varied according to hospital size, particularly for intra-aortic balloon counterpulsation, CT scanning, and intracranial pressure monitoring. Urban setting more significantly affected size and available services than did geographic region.(ABSTRACT TRUNCATED AT 250 WORDS)
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A dominant characteristic of critical-care medicine today is the emergence of powerful institutions functioning within a framework of a noncoherent set of values and philosophical perspectives. Anyone who would assign a significant role to the philosophy of medicine for today's era must not simply account for the quandaries of critical-care medicine, but also attend to the antecedent values, conflicts, and absurdities that form the ethical issues, as well as the models of ethical response (market ethos, professional ethos, etc.) that indicate which moral principles might be relevant. These considerations form the new agenda for the philosophy of critical-care medicine. This broad philosophical task is an urgent one, for critical-care medicine is rapidly molding the moral dimensions of all of medicine.
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Transcutaneous (PtcO2) and conjunctival (PcjO2) oxygen tensions and transcutaneous (PtcCO2) carbon dioxide tension were serially measured in 31 critically ill patients. Sixteen patients maintained a normal or greater blood pressure and 15 patients were severely hypotensive (MAP less than 60 mm Hg) or suffered cardiac arrest while in the emergency department. In hemodynamically stable patients, the correlations between PtcO2 and PaO2, PcjO2 and PaO2, and PtcCO2 and PaCO2 were significant, with correlation coefficients (r values) of 0.62, 0.48, and 0.73, respectively. ⋯ Transcutaneous and conjunctival sensors can be used as continuous monitors of respiratory status in hemodynamically stable patients. In severely hypotensive patients and during cardiopulmonary resuscitation, these sensors no longer accurately reflect arterial blood gases, but act as sensitive real-time monitors of cardiac function and peripheral perfusion. PcjO2 can detect deterioration of clinical state before alterations in blood pressure occur.