Critical care clinics
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Lactate is the end product of the anaerobic metabolism of glucose, and its accumulation in the blood signals an increase in production or a decrease in utilization, or both. The most common etiology of lactic acidosis is hypoperfusion, which represents an imbalance between systemic oxygen demand and oxygen availability with resultant tissue hypoxia. A wide variety of other etiologies of hyperlactatemia have been identified or implicated. ⋯ Clinical recognition of hyperlactatemia is facilitated by an awareness of the clinical settings in which it is likely to occur. Serum electrolyte and arterial blood gas studies are helpful to recognize lactic acidosis, but direct assay of blood lactate is necessary to identify milder degrees of lactate elevation, to confirm and quantitate the severity of more severe degrees, and to monitor the progress of therapy. Therapy should be directed toward measures to ensure adequate systemic oxygen delivery and specific treatment of the underlying causes.
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Catecholamines (norepinephrine, epinephrine, and dopamine) are released into circulation in response to stress and injury and as part of the body's attempt at vasoregulation in response to circulatory failure. Norepinephrine is released from sympathetic nerve terminal, and epinephrine and dopamine are released from the adrenal medulla. ⋯ These amines have both beneficial and detrimental effects on survival. Both norepinephrine and dopamine are often employed in the critically ill to selectively increase cardiocerebral and renal blood flow, respectively.
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Critical care clinics · Jul 1987
ReviewSpinal cord injury--a systems approach: prevention, emergency medical services, and emergency room management.
Spinal cord injury is considered a catastrophic disease because of the significant morbidity, mortality, and costs not only in fiscal terms but in social terms. There are approximately ten thousand new spinal cord injuries per year with the national prevalence estimated at between three and five hundred thousand Americans. These authors advocate a systems approach for the comprehensive management of these devastating injuries. In all phases of care for the spinal-cord-injured person, the key is a team approach and a commitment to an optimal patient care program that can result in minimizing patient morbidity, mortality, and the cost of care as well as making neurologic function maximal.
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Critical care clinics · Jul 1987
ReviewCritical care management of the patient with acute spinal cord injury.
The critical care management of acute injury to the cervical spinal cord is discussed from the perspective of the pathophysiology of the injury process and its ramifications. Emphasis is placed upon resolution of cardiovascular derangements, spinal cord resuscitation, and respiratory support utilizing practical therapeutic interventions.
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Critical care clinics · Apr 1987
ReviewPathophysiology, monitoring, outcome prediction, and therapy of shock states.
The time course of hemodynamic and oxygen transport patterns of survivors and nonsurvivors of high-risk critical illness patients was used to evaluate pathophysiologic mechanisms, develop outcome predictors, and propose therapeutic goals. The predictors and goals were tested prospectively and resulted in significantly reduced mortality and morbidity.