Critical care clinics
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Until recently, concern over the care of the trauma victim has largely involved the adult population; although 7% of emergency calls are for the pediatric patient, insufficient attention has been paid to the care of these children. This article concentrates on those unique problems encountered in the management of pediatric trauma in prehospital and hospital settings.
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This article presents basic anesthetic management problems and procedures together with newer anesthetic drugs and monitoring techniques that are likely to be encountered by intensive care physicians. The author's goal is to familiarize all critical care unit based members of the resuscitation team with current aspects of anesthetic management of the trauma patient.
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There appears to be reasonable evidence to support the concept of trauma centers, as well as ICUs for the critical care management of the seriously injured trauma patient. For optimal care of such patients, there must be effective delivery of such critical care. Despite some concerns as to who should provide such care to trauma patients, as well as all other patients, there is little debate over the goal of such treatment--that is, optimal care of these seriously injured patients. ⋯ With proper leadership and systems to ensure effective communication between such services, these goals can be achieved. Important secondary goals, in education and research, can also be achieved by such methods. Rather than further fractionate the care of patients, who frequently need 24-hour physician coverage and involvement of people with many different specialty areas of knowledge, it is crucial that an effective, cooperative system be designed for each institution that provides this care.
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Massive transfusion is a potentially serious problem associated with a number of complications, including changes in coagulation factor and platelet concentration, nonmechanical bleeding, hypothermia, pulmonary dysfunction, hypokalemia and hyperkalemia, hypocalcemia, hypomagnesemia, acidosis and alkalosis, immune suppression, blood transfusion reactions, and transmission of infectious diseases. The pathophysiology and management of massive transfusion are reviewed in this article.
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The early management of the multiply injured patient is discussed. Emphasis is placed on recognizing life-threatening injuries early, intervening with appropriate treatments, performing a complete initial assessment, and establishing definitive care. Specific organ systems and injuries are stressed.