Critical care medicine
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Critical care medicine · Jul 2008
ReviewInfectious disease complications of combat-related injuries.
: Strategies currently used to prevent morbidity and mortality associated with combat-related injuries include better training of frontline medical personnel, improved personal protective equipment, and deployment of fast-forward surgical assets with state-of-the-art equipment. These strategies allow patients to survive near-catastrophic injuries, placing a greater emphasis on the medical infrastructure to mitigate short- and long-term complications associated with these injuries. ⋯ : This article reviews the lessons learned from combat-related wound infections throughout history and in the current conflicts in Iraq and Afghanistan. Many of the management strategies used to prevent infections of combat-related injuries are applicable to the management of civilian trauma, whether associated with small arms fire or related to natural disasters such as earthquakes or tornadoes.
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Critical care medicine · Jul 2008
ReviewAdvances in surgical care: management of severe burn injury.
Management of combat casualties with severe burns and associated traumatic injuries requires a coordinated interaction of surgical, critical care, and evacuation assets. These patients present enormous challenges to the entire medical system as a result of the severity of injury combined with the great distance required for transport to definitive care. ⋯ Fluid resuscitation during the first 24 to 48 hrs after injury remains a significant challenge for all who manage burn casualties. Guidelines have been developed in an effort to standardize fluid resuscitation during this time. These guidelines along with the standardization of burn wound care and continued provider education have resulted in decreased morbidity and mortality in severely burned patients returning from war zones. This system of care for severely burned patients facilitates the transfer of the burn casualty between healthcare providers and facilities and is now being integrated into the catchment area for the Institute of Surgical Research Burn Center.
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Critical care medicine · Jul 2008
ReviewPrehospital advances in the management of severe penetrating trauma.
Historic advances in combat prehospital care have been made in the last decade. Unlike other areas of critical care, most of these innovations are not the result of significant improvements in technology, but by conceptual changes in how care is delivered in a tactical setting. The new concept of Tactical Combat Casualty Care has revolutionized the management of combat casualties in the prehospital tactical setting. ⋯ This article examines the most recent and salient advances that have occurred in battlefield prehospital care driven by our ongoing combat experience in the Iraq and Afghanistan and the evolution around the Tactical Combat Casualty Care concept.
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The difficult airway is a common problem in adult critical care patients. However, the challenge is not just the establishment of a safe airway, but also maintaining that safety over days, weeks, or longer. ⋯ Critical care physicians are presented with a significant number of difficult airway problems both during the insertion and removal of the airway. Critical care physicians need to be familiar with the difficult airway algorithms and have skill with relevant airway adjuncts.
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Critical care medicine · Jul 2008
Randomized Controlled Trial Multicenter StudyA randomized trial of daily awakening in critically ill patients managed with a sedation protocol: a pilot trial.
Protocolized sedation (PS) and daily sedative interruption (DI) in critically ill patients have both been shown to shorten the durations of mechanical ventilation (MV) and intensive care unit (ICU) stay. Our objective was to determine the safety and feasibility of a randomized trial to determine whether adults managed with both PS + DI have a shorter duration of MV than patients managed with PS alone. ⋯ This pilot trial comparing PS vs. PS + DI confirmed the safety and acceptability of the sedation protocol and DI, and guided important modifications to the protocol, thus enhancing the feasibility of a future multicenter trial. This trial was not designed to detect small but significant differences in clinically important outcomes.