Problem In Critical Care Research Articles

Recognition, assessment, and treatment of anxiety in the critical care patient

A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.

Heart, lung, and endocrine complications of solid tumors.

Many cancers and complications of cancer treatment may cause major critical care problems. Cardiopulmonary complications include pericardial effusion, cardiac tamponade, superior vena cava syndrome, pleural effusion, pulmonary embolism, radiation pneumonitis, and toxicities related to chemotherapy. Syndrome of inappropriate antidiuretic hormone (SIADH), Cushing's disease, and hypercalcemia are common endocrine complications associated with solid tumors. Astute nursing assessment plays an important role in preventing or reducing morbidity related to these complications.

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

The ICU Book

The author indicates that this is a generic text for all intensive care units, regardless of the name on the door. Dr Marino thereby acknowledges the multidisciplinary nature of intensive care endeavors. He has experience in both medical and surgical intensive care units and therefore presents a balanced approach as well as a range of topics that are applicable to virtually all adult critical care environments. The text is aimed at the house officer and is clearly written with liberal use of figures and tables. There is an up-to-date list of selected references at the end of each chapter. There is also a very useful set of references and appendixes at the end of the book that includes material on drug interactions, dosages, algorithms for resuscitations, and scoring systems. The book has 12 sections, including critical care physiology, common practices and problems, basic hemodynamic monitoring, and clinical shock syndrome. The

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

Problems in Critical Care

New York City's Health Care Crisis: AIDS, the Poor, and Limited Resources

To the Editor.— The commentary by Drs Ron and Roger 1 on the impact of the human immunodeficiency virus (HIV)-1 epidemic on New York City was both timely and correct in pointing to the critical and destabilizing effect of that virus on New York City. Their proposals were limited largely to increased federal funds for New York City for an expansion of acute care beds. Such a proposal is not likely to meet with enthusiasm in Washington, nor is it likely to solve New York's critical health care problems. What is urgently needed is broad reassessment and reform of New York's care institutions and services in light of the HIV health epidemic. Such reform must begin with a solid understanding of why and how New York City, with its tremendous wealth and medical resources, became the incubator of, the disseminator of, and an endemic area for HIV. This reassessment must

Cardiovascular Problems in Pediatric Critical Care

Cardiovascular Problems in Pediatric Critical Care

Suppurative thrombophlebitis: a new look at a continuing problem.

Despite knowledge of its existence and despite precautionary measures, suppurative thrombophlebitis remains a significant problem in critical care, with a reported incidence of approximately 4% and associated mortality as high as 83%. In a retrospective study, we identified additional risk factors such as emergency department or field placement of catheters and administration of potassium boluses. New guidelines for surveillance and prevention have proved successful.

High technology medicine and the physician-patient relationship

While technologic problems in critical care have become highly refined with precise solutions, ethical problems and solutions have remained fairly primitive. A useful distinction between technology and techniques is made with individual technologies being the parts that make up the therapeutic techniques as a whole. The phenomena of “technical convergence” is discussed wherein we may control each part of the system, but the system itself may be out of control. This is explained in terms of the logical fallacy of composition, noting that a whole may not necessarily have the same characteristics of its parts. Resolution of some of the ethical problems in critical care is suggested through a reexamination of the physician-patient relationship. It is noted that the relationship needs to be personal-technologic rather than sociotechnologic in nature, with the former focusing solely on the best interest of the individual patient and the latter focusing more on the broader concerns of society in the allocation of limited resources. The detrimental effects for the physician as well as the patient of the shift toward the sociotechnologic relationship is explored, especially the dehumanization of the physician. A call for a reaffirmation of the traditional professional model of medicine emphasizing the best interest of patients as opposed to the more popular business model emphasizing materialism and efficiency is given.

Cardiovascular Problems in Paediatric Critical Care

Cardiovascular Problems in Paediatric Critical Care

Renal Problems in Critical Care, edited by Lynn Schoengrund and Pamela Balzer. New York

Renal Problems in Critical Care, edited by Lynn Schoengrund and Pamela Balzer. New York

Zur tuberkulösen Meningitis in der Intensivtherapie

A case of tuberculous meningitis in a 2-year-old boy is reported. The main critical care problems are irregular breathing, raised intracranial pressure and syndrome of inappropriate secretion of antidiuretic hormone. Cranial CT-Scan and ventricular shunting are shown to be of high importance for this disease.

Critical care problems in neonates. Colloid osmotic pressure in healthy and sick neonates.

Clinical usefulness of colloid osmotic pressure (COP) measurements in adults has been well established. However, data in healthy and sick neonates are sparse. The present study established the COP changes in healthy term and preterm infants and in critically ill neonates. COP in healthy term (16.9 +/- 1.9 mm Hg) and preterm (15.4 +/- 1.3) infants was significantly lower than adults (21.6 +/- 3.6). Even in sick neonates, COP correlated with gestational age (n = 78, r = 0.63, p less than 0.001 , birth weight (r = 0.58, p less than 0.001) and total protein (n = 71, r = 0.58, p less than 0.001). Critically ill preterm infants with hyaline membrane disease had the lowest COP (11.5 +/- 1.2). Administration of 10% albumin failed to increase the COP significantly. In critically ill preterm infants who survived, the COP increased during the first postnatal week, whereas in nonsurvivors COP decreased significantly to less than 10 mm Hg.

A critical care problem in neonates. Exchange transfusions through peripheral artery.

A critical care problem in neonates. Exchange transfusions through peripheral artery.