Articles: critical-care.
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Prehospital resuscitation and stabilization of major trauma victims is increasingly employed. To evaluate the benefits of one such maneuver, fluid administration, we reviewed 52 consecutive trauma cases in which patients had a blood pressure of less than 100 mm Hg either at the scene or on arrival to hospital. ⋯ A percentage of patients with correctable surgical lesions might have been salvaged had prompt transport been instituted. Field maneuvers in critically injured patients should be minimized to decrease ultimate mortality.
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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.