Articles: critical-care.
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Endocrine metabolic emergencies are common clinical entities seen by most health care professionals in acute care medicine. Except for cardiopulmonary arrest, few situations require such rapid institution of immediate drug therapy to reverse life-threatening metabolic imbalances. To safely guide patients through these situations, the physician requires a basic knowledge and familiarity with the approaches, indications, and limitations of drug therapy as a component of care.
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Critical care medicine · Feb 1984
Results, charges, and benefits of intensive care for critically ill patients: update 1983.
Objective and quantitative methods were used to measure severity of illness and outcome of intensive care in critically ill patients, in terms of success or failure of therapy within the ICU, survival or death at 1 yr, quality of life in survivors, and utilization of resources. One hundred ninety-nine consecutive Class IV critically ill surgical patients hospitalized between 1977 and 1978 at the Massachusetts General Hospital comprised the study population. Although the mortality rate of 69% was close to the 73% rate we recorded for 1972-1973, the survivors' quality of life was significantly better. ⋯ Survival rates and quality of life in survivors did not vary with age. The disease process for which the patient was hospitalized was an important determinant of outcome. Intensive care medicine for critically ill surgical patients does prolong life and enable some patients to return to a productive lifestyle; however, the costs of these benefits are extremely high.
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Critical care medicine · Feb 1984
Reliability of clinical monitoring to assess blood volume in critically ill patients.
Blood volumes measured by indicator dilution method in over 1500 instances of critically ill patients of various etiologies and at various times throughout their critical illness were compared with the values of concomitantly measured mean arterial pressure (MAP), CVP, pulmonary arterial wedge pressure (WP), Hct, and cardiac output. During resuscitation from hypovolemic shock, the patients' blood volumes and the monitored variables were significantly altered. ⋯ With administration of a fluid load, blood volume and values of the commonly monitored variables improved appropriately, but the correlation coefficients, in general, were not good. The data suggest that the commonly monitored variables, in and of themselves, do not reflect adequately the blood volume status in critically ill patients.
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13 cases of severe cerebral trauma were subjected to varying degrees of elevation of the upper trunk (0 degrees, 15 degrees, 30 degrees, 45 degrees) and to head-raising only (0 degrees, 15 degrees, 30 degrees). The intracranial pressure and mean arterial pressure were measured in these positions. On raising the upper half of the body by 15 degrees, intracranial pressure fell from a mean of 35.3 mm Hg to 28.7 mm Hg, and to 25.2 mm Hg on raising to 30 degrees. ⋯ In contrast, the mean arterial pressure fell constantly as elevation increased, resulting in a decrease in cerebral perfusion pressure at levels above 30 degrees. In no cases did raising of the head alone result in a lowering of pressure. Instead, potentially dangerous increases were observed.