Endocrinology

2019 ◽  
pp. 100-105
Author(s):  
Navneet Kaur Grewal ◽  
George W. Williams
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Neurological Disease ◽  
Endocrine System ◽  
Postoperative Management ◽  
Critically Ill Patient ◽  
The Core ◽  
Examination Board ◽  
Ideal Method ◽  
Neurological System

Endocrinology is a topic that is tightly aligned with neurological disease, infectious diseases, nephrology, and postoperative management; in fact, the endocrine system is a chemical version of the neurological system. In many respects, it is entangled with all of critical care and is a substantial topic even on the core anesthesiology examination. In the same vein, endocrinopathies of various types are an ideal method through which an examination board can generate material. When once considers the scope and breadth of endocrinopathies, this system generally effects every critically ill patient while also serving as an indicator for disease in other systems. These concepts are empowering when mastered and add tremendous clinical dexterity to the clinician when applied in the intensive care unit.

Chronic Critical Illness

2010 ◽  
Vol 21 (1) ◽  
pp. 44-61 ◽  
Author(s):  
Clareen Wiencek ◽  
Chris Winkelman
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Critical Care ◽  
Critical Illness ◽  
Critically Ill Patient ◽  
Essential Information ◽  
Chronic Critical Illness ◽  
Financial Burdens ◽  
Chronically Critically Ill ◽  
Proactive Care

The syndrome of chronic critical illness has well-documented emotional, social, and financial burdens for individuals, caregivers, and the health care system. The purpose of this article is to provide experienced acute and critical care clinicians with essential information about the prevalence and profile of the chronically critically ill patient needed for comprehensive care. In addition, pathophysiology contributing to chronic critical illness is addressed, though the exact mechanism underlying the conversion of acute critical illness to chronic critical illness is unknown. Clinicians can use this information to identify at-risk intensive care unit patients and to institute proactive care to minimize burden and distress experienced by patients and their caregivers.

Pathophysiology, diagnosis, and assessment of acute or chronic hepatic failure

2016 ◽  
Author(s):  
Alastair O’Brien
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Liver Failure ◽  
Clinical Assessment ◽  
Inflammatory Responses ◽  
Critically Ill Patient ◽  
Separate Entity ◽  
Chronic Liver Failure ◽  
The Core

Cirrhosis is an increasing problem and prognosis following intensive care unit admission is poor. Acute on chronic liver failure (ACLF) is a separate entity to cirrhosis with organ failure at the core of this syndrome. Infection and the associated systemic inflammatory responses are the most important precipitants of ACLF. Clinical assessment should follow the standard airway breathing circulation disability exposure approach to the critically-ill patient.

The Meaning of Our Work

2011 ◽  
Vol 22 (4) ◽  
pp. 397-407
Author(s):  
Clareen A. Wiencek ◽  
Betty R. Ferrell ◽  
Molly Jackson
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Moral Distress ◽  
Survival Rates ◽  
Critically Ill Patient ◽  
Current Profile ◽  
Patients With Cancer ◽  
A Current

The prevalence and survival rates of critically ill patients with cancer in the intensive care unit have increased considerably in the past 2 decades; yet, the meaning of caring for cancer patients in this setting may fall along a continuum. This article addresses the nurse’s experience in caring for the critically ill patient with cancer by presenting a current profile of these patient in the intensive care unit in the context of the historical development and mission of critical care and the evolution of cancer as a chronic disease. The moral distress that can result when these 2 “cultures” or “realities” collide and the meaning of the nurse’s work will be examined. Strategies and resources for critical care nurses to incorporate into their practice when caring for the critically ill patient with cancer, and themselves, will be addressed.

Critical Care for the Surgical Patient

2002 ◽  
Vol 12 (7) ◽  
pp. 258-265 ◽  
Author(s):  
Chris Aps
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Postoperative Management ◽  
Surgical Patient ◽  
Care Provision ◽  
Fast Tracking ◽  
Patient Dependency ◽  
The Impact

Dr Chris Aps has been involved, since the early 1980s, with the impact of the surgical patient on critical care provision. At that time, he established clinical techniques to lower patient dependency after cardiac surgery. This allowed for the postoperative management of such patients in a general recovery facility rather than in the formal Intensive Care Unit (ICU). This became known as cardiac fast-tracking and led to the development of the Overnight Intensive Recovery (OIR) concept.

scholarly journals Rapid Ultrasound Methods in Anesthesiology and Critical Care Medicine

2015 ◽  
Vol 25 (2) ◽  
pp. 94-102
Author(s):  
Andrius Macas ◽  
Asta Mačiulienė ◽  
Sandra Ramanavičiūtė ◽  
Alina Vilkė ◽  
Kęstutis Petniūnas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Critical Care ◽  
Intensive Care ◽  
Trauma Patient ◽  
Standard Of Care ◽  
Intensive Care Unit Setting ◽  
Critically Ill Patient ◽  
Essential Information ◽  
Ultrasound Applications

The variety of focus assessed ultrasound applications and protocols in emergency department and intensive care unit setting is growing. Focus assessed protocols can provide essential information about critically ill patient. It is now the standard of care to perform focused assessment using sonography for trauma - FAST early in the evaluation of trauma patient. Other focus assessed protocols can prove to be useful as well as FAST.

scholarly journals Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort

2021 ◽  
Author(s):  
Marie-Madlen Jeitziner ◽  
André Moser ◽  
Pedro D Wendel-Garcia ◽  
Matthias Thomas Exl ◽  
Stefanie Keiser ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patient ◽  
Icu Mortality ◽  
Swiss Health ◽  
Increased Risk ◽  
Staffing Ratio ◽  
Secondary Study

Abstract Background The modifications to the standard intensive care unit (ICU) organization that had to be urgently implemented worldwide to overcome the surge of ICU admissions due to patients with a severe coronavirus disease 2019 (COVID-19) have resulted in increased workload and patients-to-nurse ratio. The aim of this study was to investigate whether level of critical care staffing could be associated with an increased risk of ICU mortality (primary endpoint), length of stay, mechanical ventilation and the evolution of disease (secondary study endpoints) in critically ill patients with COVID-19. Methods Retrospective multicenter analysis of the international Risk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry that prospectively enrolls patients developing critical illness due to COVID-19 in several countries worldwide. The analysis was limited to the period between March 1st, 2020 and May 31st, 2020, to ICUs in Switzerland that have collected additional data on nurse and physician staffing. Hierarchical regression models were used to investigate crude and adjusted effects of critical care staffing ratio on study endpoints. We adjusted for diseases severity and weekly caseload. Results Among the 38 Swiss participating ICUs, 17 recorded critical care staffing information. The study population included 437 patients and 2342 daily assessments of patient-to-nurse/physician ratio. Median of daily patient-to-nurse ratio started at 1.0 ([IQR] 0.5–1.5; calendar week 9) and peaked at 2.4 (IQR 0.4-2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1-5.0; calendar week 9) and peaked at 6.8 (IQR 6.3–7.3; calendar week 19). Neither the patient-to-nurse ratio [adjusted Odds Ratio (OR) 1.28, 95% confidence interval (CI) 0.85–1.94; doubling of ratio] nor the patient-to-physician ratio [adjusted OR 1.08, 95% CI 0.87–1.32; doubling of ratio] was associated with ICU mortality. We found no association of critical care staffing on the investigated secondary study endpoints in adjusted models. COnclusion The Swiss health care system successfully overcame the first wave of the COVID-19 pandemic with regards to the unprecedented demand for ICU treatments. The reduced availability of critical care staffing resources per critically ill patient in Swiss ICUs did not translate in an overall increased risk of mortality.

Compatibility of Intravenous Drugs in a Coronary Intensive Care Unit

1986 ◽  
Vol 20 (5) ◽  
pp. 349-352 ◽  
Author(s):  
Joseph F. Dasta ◽  
Frederick P. Zeller ◽  
Robert J. Anders
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Setting ◽  
Setting Time ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Accessible Information ◽  
The Stability ◽  
Physical And Chemical

In a coronary intensive care unit (CCU) it is often necessary to utilize extensive pharmacologic interventions and multiple intravenous medications in order to stabilize a critically ill patient. However, the necessity of several intravenous infusions often presents the problem of compatibility of these medications when infused within a common line. The pharmacist must possess adequate skill to identify potential incompatibilities by retrieving information on the physical and chemical compatibilities of various intravenous medications. In a critical care setting, time is an important factor, and information that can be obtained rapidly and reliably is vital for the pharmacist to prevent the administration of an irritating substance or a medication that has undergone deterioration as a result of chemical inactivation. A compatibility table containing the most commonly used drugs in a CCU has been developed based on currently available literature, including standard reference texts, about these medications. The table outlines the potential for interactions, within a single intravenous line, when several drugs are infused concurrently. In addition, a review of the concepts of physical and chemical incompatibility is presented. The stability of an admixture is defined utilizing requirements established in the USP NF monographs and manufacturers' specifications. The resulting table concisely organizes vital information in a form that allows rapid, accessible information to the pharmacist in a critical care setting, where it is most needed.

Valvular stenosis

2020 ◽  
pp. 195-206
Author(s):  
Ana Martinez-Naharro ◽  
Susanna Price
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Setting ◽  
Multimodality Imaging ◽  
Clinical Status ◽  
Critical Care Setting ◽  
Critically Ill Patient ◽  
Valvular Stenosis ◽  
Echocardiographic Parameters

Evaluation of valve stenosis in the critical care setting can be challenging, as the clinical status of the patient may preclude the gold standard for assessment (multimodality imaging), demanding reliance on echocardiographic parameters that are not well-validated in the intensive care unit. Valve stenosis is common, and where it precipitates intensive care admission is likely to be severe, and affecting the left-sided valves. On occasion, however, stenosis may be an incidental finding in a critically ill patient with a variable impact on their clinical status. Right-sided lesions are rare (outside the grown-up congenital patient population) and only very infrequently lead to acute haemodynamic deterioration. Echocardiography is indicated in any intensive care unit (ICU) patient where there is suspicion of valvular heart disease. This chapter outlines how to assess valvular stenosis and define its severity in the critical care setting according to integrated echocardiographic parameters. It highlights how critical care pathophysiology may complicate this evaluation, and any potential pitfalls that may exist.

scholarly journals A Timely Call to Arms: COVID-19, the Circadian Clock, and Critical Care

2021 ◽  
Vol 36 (1) ◽  
pp. 55-70
Author(s):  
Jeffrey Haspel ◽  
Minjee Kim ◽  
Phyllis Zee ◽  
Tanja Schwarzmeier ◽  
Sara Montagnese ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Human Physiology ◽  
Critical Care ◽  
Intensive Care ◽  
Severe Acute Respiratory Syndrome ◽  
Circadian Clock ◽  
Clinical Course ◽  
Disease Expression ◽  
Severe Manifestation ◽  
Novel Coronavirus

We currently find ourselves in the midst of a global coronavirus disease 2019 (COVID-19) pandemic, caused by the highly infectious novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we discuss aspects of SARS-CoV-2 biology and pathology and how these might interact with the circadian clock of the host. We further focus on the severe manifestation of the illness, leading to hospitalization in an intensive care unit. The most common severe complications of COVID-19 relate to clock-regulated human physiology. We speculate on how the pandemic might be used to gain insights on the circadian clock but, more importantly, on how knowledge of the circadian clock might be used to mitigate the disease expression and the clinical course of COVID-19.

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