Current opinion in critical care
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Ethical issues have emerged in recent years as a significant component of care in the critically ill patient. Recently, the primary emphasis has been directed to care at the end-of-life. ⋯ This leads to tremendous potential for conflict between the physician and the family, as the patients are often incapable of participating in any discussion regarding end-of-life care. Advance planning on the part of the patient in terms of making their wishes known and education of the health care professionals is essential in promoting effective communication, thereby avoiding conflict in these difficult end-of-life decisions.
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Curr Opin Crit Care · Dec 2001
ReviewPrehospital and resuscitative care of the head-injured patient.
The ultimate neurologic outcome following severe head trauma depends on the extent of primary brain insult sustained at the time of the trauma itself, and the subsequent neurochemical and neurophysiologic pathologic changes occurring as a result of the injury. Although there are currently no specific therapies that have proven to be consistently effective in reversing the devastating consequences of primary brain insult, the reduction or prevention of secondary brain insult is possible. ⋯ As new data are accumulated, traditional and new therapies for severe head injury have come under scrutiny. While no absolute standards have been advanced, guidelines have been established that can help direct the acute stabilization of severely head injured patients.