Articles: critical-care.
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One of the major developments in health care has been the evolution of critical-care medicine. This concept* encompasses total care of patients from the initiation of an illness or injury, through all their sophisticated care, until the patient has either recovered or succumbed. The concept of critical-care medicine has actually evolved only over the past decade. ⋯ A multidisciplinary unit is described as one of four alternative approaches. Participants in such planning for this area of patient care must include physicians, nurses and technologists, architects, biomedical and clinical engineers, biomedical technologists, and all hospital department heads who might not necessarily be directly involved in this kind of patient care, but who do, in fact, participate in some fashion. Our obligation is obvious, and the need to familiarize all involved with this concept of patient care and its urgency are discussed.
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Although monitoring of critically ill patients has made giant steps forward in the past 15 years, such monitoring techniques must be viewed as a calculated risk, since a small but finite proportion of patients who are monitored by invasive techniques will suffer untoward and, occasionally, catastrophic consequences. Minimizing the risk involves careful general evaluation of the patient, adherence to strict indications for use of invasive techniques, and care coupled with experience in the actual manipulation. ⋯ The treatment of all critically ill patients must be individualized, and the monitoring techniques employed should be similarly individualized. With such a judicious approach, a great deal of valuable information can be obtained, and an effective and intelligent therapeutic regimen outlines so as to assure a successful outcome in as many patients as possible.
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A case of human rabies is reported showing a peculiar course in some respects. The lack of a satisfactory history concerning an animal bite 5 months earlier as well as a misleading psychiatric history led to difficulty and delay in reaching a diagnosis. ⋯ The clinical course and the pathological findings are described in detail and the etiology and prognosis of the disease are discussed. The latter remains rather hopeless de spite modern intensive care.