Critical care clinics
-
Critical care clinics · Apr 1986
ReviewAbdominal binding and counterpulsation in cardiopulmonary resuscitation.
During the past 15 years, many different studies have documented improved blood pressure and blood flow above the diaphragm when some type of abdominal compression was added to conventional CPR, either in animals or in humans. Rhythmically interposed abdominal compressions seem to provide even greater hemodynamic benefit than continuous abdominal binding. ⋯ It requires no special equipment, and could be easily incorporated into existing training programs for basic rescuers. In this sense the technique may constitute a logical evolution in basic life support, if subsequent clinical research confirms that it improves outcome.
-
A large body of experimental data indicates that blood flows during CPR because of elevations of intrathoracic pressure and the uneven peripheral transmission of this pressure. Data from humans are less extensive, but also strongly support the mechanism of intrathoracic pressure. It should be remembered that the intrathoracic pressure and direct cardiac compression hypotheses are not mutually exclusive, and that effective CPR is above all dependent on vigorous chest compression. ⋯ These data demonstrate that CPR is an effective means of supporting the circulation during cardiac arrest. The majority of survivors return to a meaningful existence, and the technique has not burdened society with a large load of neurologically impaired patients. Thus, CPR is very much worthy of the full attention and support of the medical community.
-
Burnout may be one of the most common problems affecting critical care physicians. Burnout can best be defined as disillusionment and a flattening of the effervescence of life. Recognizing the symptoms of burnout and the sources of stress enables one to incorporate preventive strategies and self-rescue techniques.
-
Increasingly, the ethics of resource allocation is becoming one of the most critical ethical problems faced by critical care decision makers; what is lacking is a framework for analyzing the ethics of decisions in resource allocation. This article examines the four ethical principles--patient-centered beneficence, autonomy, full beneficence, and justice--that can contribute to cost containment/resource allocation.
-
This article identifies the ethical principles that have guided medicine since antiquity: beneficence, primum non nocere, patient autonomy, and respect for life and the quality of life. The author's basic premise is that many recently publicized ethical dilemmas are really not dilemmas--the knowledge of what is good or evil is not confused, contradictory, or absent. Instead, medicine's concern and responsibility to its patients is being clouded by legal, governmental, or societal concerns.