Articles: critical-illness.
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Critical care clinics · Jul 1992
ReviewTransport of the critically ill patient with upper airway obstruction.
Upper airway obstruction is a life-threatening emergency requiring prompt evaluation and careful intervention. The pathophysiology of upper airway obstruction is reviewed. Assessment techniques and stabilization are discussed with specific attention to intervention and stabilization prior to transport.
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Transthoracic echocardiography is an easily accessible, non-invasive imaging procedure for evaluation and follow-up of critically ill patients. It is particularly helpful in evaluating patients with thoracic pain, low-output syndrome or heart murmur, and has prognostic value in acute myocardial infarction. It makes a diagnostic contribution in 60 to 90% of cases, and has therapeutic implications in 50 to 65%. New ultrasound technics are briefly discussed.
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Critical care medicine · May 1992
ReviewSelective decontamination of the digestive tract in the intensive care unit: current status and future prospects.
To evaluate the available data on selective decontamination of the digestive tract. This therapy aims to prevent infection in critically ill patients admitted to ICUs. Microbial carriage in the oropharynx, stomach, and gut; infection; mortality rate; and antibiotic resistance are the outcome events that are being reviewed. ⋯ There is a general consensus about the efficacy of selective decontamination in diminishing microbial carriage and acquired infection rates, although conclusions about benefits related to mortality rates vary. Differences in mortality rate are found in the selective decontamination studies of patients with curable diseases, including multitrauma and cardiovascular patients. More data on resistance, collected over a longer period of time, are needed. Practical problems of blinding and the major ecological effect of selective decontamination may explain the lack of a randomized, placebo-controlled, double-blind trial.
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AACN Clin Issues Crit Care Nurs · May 1992
ReviewEndocrine responses to the stress of critical illness.
The physiologic and psychologic stress of critical illness produces systemic endocrine responses that affect the body's ability to achieve and maintain homeostasis. Regardless of the nature of the stress or illness, specific hormonal changes occur in thyroid, adrenal, and posterior pituitary activity. This article describes the physiologic and pathophysiologic basis underlying endocrine responses to the stress of critical illness. The critical care nurse is challenged by the complexity of this patient and needs to be familiar with the endocrine responses to critical illness for assessment and clinical interventions to be meaningful.