Current opinion in critical care
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Curr Opin Crit Care · Dec 2002
ReviewEarly intensive care unit intervention for trauma care: what alters the outcome?
This review focuses on early management of multiple trauma patients with traumatic brain injury. Early usage of multislice computed tomography can substantially shorten the time spent on diagnostic workup in the emergency room and, therefore, speeds the initiation of lifesaving interventions for the control of hemorrhage. The important role of hemostatic angiographic embolization and its timing, in addition to surgical control of bleeding in patients suffering from pelvic fracture or organ lesions, is emphasized. ⋯ A novel approach to reduce major bleeding is the application of recombinant factor VIIa. Strong effort should be directed toward the management of traumatic brain injury and the maintenance of cerebral perfusion pressure. The optimization of treatment of patients with multiple trauma, including brain injury, is a multidisciplinary task.
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Curr Opin Crit Care · Dec 2002
ReviewClinical information systems and the electronic medical record in the intensive care unit.
The integration of computers into critical care is by no means a new concept. Clinical information systems have evolved in the critical care setting over the past three decades. ⋯ Clinical information systems and the electronic medical record in the ICU have the potential to improve medical record movement problems, to improve quality and coherence of the patient care process, to automate guidelines and care pathways, and to assist in clinical care and research, outcome management, and process improvement. In this article, we provide some historical background on the clinical information system and the electronic medical record and describe their current utilization in the ICU and their role in the practice of critical care medicine in decades to come.
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Curr Opin Crit Care · Dec 2002
ReviewTechniques for assessing and achieving fluid balance in acute renal failure.
Fluid therapy, together with attention to oxygen supply, is the cornerstone of resuscitation in all critically ill patients. Hypovolemia results in inadequate blood flow to meet the metabolic requirements of the tissues and must be treated urgently to avoid the complication of progressive organ failure, including acute renal failure. The kidney plays a critical role in body fluid homeostasis. ⋯ Although the importance of fluid management is generally recognized, the choice of fluid, the amount, and assessment of fluid status are controversial. As the choice of fluids becomes wider and monitoring devices become more sophisticated, the controversy increases. This article provides an overview of the concept of fluid management in the critically ill patient with acute renal failure.
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Curr Opin Crit Care · Dec 2002
ReviewSpinal immobilization in trauma patients: is it really necessary?
The acute management of potential spinal injuries in trauma patients is undergoing radical reassessment. Until recently, it was mandatory that nearly all trauma patients be immobilized with a back board, hard cervical collar, head restraints, and body strapping until the spine could be cleared radiologically. This practice is still recommended by many references. ⋯ Low-risk patients can be safely cleared clinically, even by individuals who are not physicians. Patients at high risk for spinal instability should be removed from the hard surface to avoid tissue ischemia. Understanding the rationale for these changes requires knowledge of mechanisms of injury, physiology, and biomechanics as they apply to spinal injuries.