Current opinion in critical care
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Critical care medicine is a relatively young specialty that was developed in response to potentially reversible life-threatening illness and was facilitated by developments such as new drugs, support equipment, and monitoring technology. It has been largely practiced within the four walls of an intensive care unit (ICU). However, now there are increasing numbers of critically ill and at-risk patients in acute hospitals who are suffering potentially preventable, serious complications that may result in death because of a lack of appropriate systems, skills, and expertise outside of the ICU. Critical care specialists are expanding their roles beyond the four walls of their ICUs and becoming involved with strategies such as the medical emergency team, a concept designed to recognize critical illness early and to respond rapidly to resuscitate patients wherever they are in the hospital.
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The changing landscape of health care has resulted in an increase in the delivery of critical care in the emergency department. Although the emergency department duration is brief compared with the total length of hospitalization, physiologic determinants of outcome may be established before ICU admission. The care provided during the emergency department stay for critically ill patients has been shown to significantly impact the progression of organ failure and mortality. ⋯ The need to maximize patient throughput in frequently overcrowded emergency departments hinders the provision of optimal care to the critically ill patient. Methodologies should be developed to examine the quality of patient care and objectively measure the impact of clinical interventions. The potential to improve outcome through educational initiatives and resource allocation should not be viewed as a burden of delivering a higher level of care in this setting but as a significant opportunity to effectively mitigate the socioeconomic consequences.
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Curr Opin Crit Care · Dec 2002
ReviewRole of rapid sequence induction for intubation in the prehospital setting: helpful or harmful?
Use of rapid sequence induction for intubation was introduced to the prehospital environment in the hope of enhancing patient outcome by improving early definitive airway management. Varying success has been achieved in both air and ground transport emergency medical services systems, but concern persists about the potential to cause patients harm. ⋯ Therefore, the value of rapid sequence induction for intubation is dependent on each emergency medical services system design in their ability to establish personnel requirements and ongoing training, expertise in airway management skills, medical direction and supervision, and a quality assurance program. If these principles are strictly adhered to, rapid sequence induction for intubation may be safely used as an advanced airway management technique in the prehospital setting.