Articles: critical-care.
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A questionnaire circulated to members of the Intensive Care Society in England and Wales brought 101 replies, representing 74 hospitals, including 16 teaching hospitals. Anaesthesia is the dominant specialty in this field and the majority of general units included in this survey are staffed and directed by consultants from this specialty, though their involvement in such work varies widely. Only about half the units are largely supervised by consultants with a heavy commitment to it. ⋯ Despite this agreement on special training, only a small minority of members believe intensive care work should largely be restricted to separate career specialists, "intensivists'. However most recognise the need for each unit to have a largely full-time manager and coordinator, whose personal qualities are more important than his original specialty. Most units have one kind of problem or another, the most common being a shortage of money and nurses.
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The suitability of lorazepam as a sedative for use in intensive care has been critically evaluated in 36 severely ill patients. The efficacy of lorazepam has been evaluated by regular measurements of both cardiovascular and neurological status as well as by the nursing staff directly involved with the care of the patients. ⋯ The benefits of the predictable and even sedation produced by a long-acting drug of this nature are discussed. Particular attention has been paid to the possibility of accumulation of lorazepam in a similar way to that of diazepam, and the relative advantages of the two drugs for use in the intensive care situation have been compared.
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Based on extensive experience and studies, some guidelines for the treatment of meningococcal disease are presented. The physician should be watchful for signs of meningococcal disease in its early phases and be ready to institute antibiotic and fluid therapy immediately. ⋯ Antibiotic therapy for household contacts should be instituted as rapidly as possible. In this way it is hoped that the toll from this devastating infection in Norway may be lessened.