Articles: critical-care.
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MMW Munch Med Wochenschr · Sep 1975
[The limits of the doctor's duty in intensive medicine (author's transl)].
The technical possibilities of intensive care, bound up with hope and torment for those treated, call for limitation of the duties of the doctor at the point where the treatment becomes mere technical brilliance and utterly pointless for the survival or subsequent life of the patient. The doctor's problem is to know when a treatment is hopeless. ⋯ An attempt is made to draw up a series of degrees of intensive therapy for practical purposes. The performance of such a graded therapy, which in the last analysis consists of the stage by stage disposal of maximum possibilities of treatment, demands the capacity to think, the courage of responsibility and a great wealth of psychological and human insight.
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In critically ill patients there is frequently more than one problem, which may not be obvious, contributing to the shock state. The history, physical exam, and monitoring devices may not be reliable individually, but must be considered together and interpreted in the light of the pathophysiologic mechanisms involved. A plan for monitoring and treating critically ill patients is outlined. The advantages and limitations of various monitoring techniques are discussed.
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Critical care medicine · May 1975
Second annual SCCM lecture. The role of hemodynamic monitoring in the management of the critically ill.
Balloon flotation catheterization of the central circulation provides data which may be most meaningful and important to the management of critically ill patients. It allows the measurements of the filling pressures of the right and left ventricle as well as the cardiac output. These data combined with information concerning cardiac rhythm, heart rate, arterial pressure and other variables place the principal determinants of cardiac function at the disposal of the critical care personnel. ⋯ Others are rapidly assessing the importance of the cardiac output and other parameters of cardiac function on a semi-continuous basis. Thus, balloon flotation catheterization has allowed the application of sound physiological principles to the understanding of circulatory abnormalities characterizing important patient illnesses and provides a rational basis for the selection of therapy with objective quantitative assessment of responses. The procedures are simple: the complications rate is low, and the information provided is highly relevant to clinical practice.