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Encyclopedia > Intensive care medicine

Intensive Care Medicine or critical care medicine is a branch of medicine concerned with the provision of life support or organ support systems in patients who are critically ill and who usually require intensive monitoring. Image File history File links Broom_icon. ... Intensive Care is the ninth album and sixth solo studio album by English pop singer Robbie Williams, released on October 24, 2005 in the United Kingdom. ... Life support, in the medical field, refers to a set of therapies for preserving a patients life when essential body systems are not functioning sufficiently to sustain life unaided. ...


Patients requiring intensive care usually require support for hemodynamic instability (hypertension/hypotension), airway or respiratory compromise (such as ventilator support), acute renal failure, potentially lethal cardiac dysrhythmias, and frequently the cumulative affects of multiple organ system failure. Patients admitted to the intensive care unit not requiring support for the above are usually admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Hemodynamics (literally, blood dynamics), or hemorheology, is the study of the properties and flow of blood. ... This article does not cite its references or sources. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ...


Ideally, intensive care is usually only offered to those whose condition is potentially reversible and who have a good chance of surviving with intensive care support. Since the critically ill are close to dying the outcome of this intervention is difficult to predict. Many patients therefore still die in the Intensive Care Unit. A prime requisite for admission to an Intensive Care Unit is that the underlying condition can be overcome. Therefore treatment is merely meant to win time in which the acute affliction can be resolved. An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ...


Medical studies suggest a relation between intensive care unit(ICU) volume and quality of care for mechanically ventilated patients.[1] After adjustment for severity of illness, demographic variables, and characteristics of the ICUs (including staffing by intensivists), higher ICU volume was significantly associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality (for a patient at average predicted risk for ICU death) was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, and 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually. Hospitals with intermediate numbers of patients had outcomes between these extremes.


It is generally the most expensive, high technology and resource intensive area of medical care. In the United States estimates of the 2000 expenditure for critical care medicine ranged from US$15-55 billion accounting for about 0.5% of GDP and about 13% of national health care expenditure (Halpern, 2004). 2000 (MM) was a leap year starting on Saturday of the Gregorian calendar. ...

Contents

Organ Systems

Intensive care usually takes a system by system approach to treatment, rather than the SOAP (subjective, objective, analysis, plan) approach of high dependency care. The nine key systems (see below) are each considered on an observation-intervention-impression basis to produce a daily plan. As well as the key systems Intensive care treatment also raises other issues including psychological health, pressure points, mobilisation and physiotherapy, and secondary infections. A SOAP note is written by health care providers after examining a patient. ...


The nine key IC systems are (alphabetically): cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract (and nutritional condition), hematology, microbiology (including sepsis status), peripheries (and skin), renal (and metabolic), respiratory system. The circulatory system or cardiovascular system is the organ system which circulates blood around the body of most animals. ... A diagram showing the CNS: 1. ... Major endocrine glands. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and... Hematology is the branch of medicine that is concerned with blood and its disorders. ... An agar plate streaked with microorganisms Microbiology is the study of microorganisms, which are unicellular or cell-cluster microscopic organisms. ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... The Respiratory System Among four-legged animals, the respiratory system generally includes tubes, such as the bronchi, used to carry air to the lungs, where gas exchange takes place. ...


The provision of intensive care is generally administered in a specialized unit of a hospital called the Intensive Care Unit (ICU) or Critical Care Unit (CCU). Many hospitals also have designated intensive care areas for certain specialities of medicine, such as the Coronary Care Unit (CCU) for heart disease, Medical Intensive Care Unit (MICU), Surgical Intensive Care Unit (SICU), Pediatric Intensive Care Unit (PICU), Neuroscience Critical Care Unit (NCCU), Overnight Intensive Recovery (OIR), Shock/Trauma Intensive Care Unit (STICU), Neonatal Intensive Care Unit (NICU), and other units as dictated by the needs and available resources of each hospital. The naming is not rigidly standardized. For a time in the early 1960`s it was not clear that specialized intensive care units were needed and intensive care resources (see below) were brought to the room of the patient who needed the additional monitoring, care, and resources. It became rapidly evident, though, that a fixed location where intensive care resources and personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. A physician visiting the sick in a hospital. ... An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ...


Equipment and Systems

Common equipment in an intensive care unit (ICU) includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy; hemofiltration equipment for acute renal failure; monitoring equipment; intravenous lines for drug infusions fluids or total parenteral nutrition, nasogastric tubes, suction pumps, drains and catheters; and a wide array of drugs including inotropes, sedatives, broad spectrum antibiotics and analgesics. mechanical or forced ventilation is the use of powered equipment, e. ... This article or section does not adequately cite its references or sources. ... Completed tracheostomy: 1 - Vocal cords 2 - Thyroid cartilage 3 - Cricoid cartilage 4 - Tracheal cartilages 5 - Balloon cuff A tracheotomy or tracheostomy is a surgical procedure performed on the neck to open a direct airway through an incision in the trachea (the windpipe). ... In medicine, hemofiltration, also haemofiltration, is a renal replacement therapy similar to hemodialysis which is used almost exclusively in the intensive care setting. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, circumventing the gut. ... A nasogastric tube (NG tube) is a plastic tube, inserted into a nostril through the nose, into the throat, down the oesophagus and into the stomach. ... Catheter disassembled In medicine, a catheter is a tube that a health professional may insert into part of the body. ... Pharmacology (in Greek: pharmacon (φάρμακον) meaning drug, and logos (λόγος) meaning science) is the study of how substances interact with living organisms to produce a change in function. ... An inotrope is an agent which increases or decreases the force or energy of muscular contractions. ... A sedative is a drug that depresses the central nervous system (CNS), which causes calmness, relaxation, reduction of anxiety, sleepiness, slowed breathing, slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... For other uses of painkiller, see painkiller (disambiguation) An analgesic (colloquially known as painkiller) is any member of the diverse group of drugs used to relieve pain. ...


Physicians, Veterinary Criticalists and Intensivists

Physicians that practice in an intensive care unit historically have been the same physicians that care for the patient before transferring to the ICU. This is still commonly the case. In some hospitals there is a special group of physicians that staff the ICU, known as Intensivists, which is becoming a speciality. Whether the intensivist becomes the lead doctor or a consultant on a case is a matter of policy in each hospital. The speciality is unusual among the specialties of medicine in that their backgrounds may be Pulmonary, Anesthesiology, Internal Medicine, or other specialties. The reason for the high representation of Pulmonary and Anesthesiology is the need to be familiar with ventilator management, although ventilating generally healthy individuals in the case of surgery is entirely different from ventilating in case of respiratory insufficiency. An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ...


In veterinary medicine, critical care medicine is recognized as a specialty and is closely allied with emergency medicine. Board-certified veterinary critical care specialists are known as criticalists, and generally are employed in referral institutions or universities. Veterinary medicine is the application of medical, diagnostic, and therapeutic principles to companion, domestic, exotic, wildlife, and production animals. ...


Patient management in intensive care differs significantly between countries. In Australia, where Intensive Care Medicine is a well established speciality, ICUs are described as 'closed'. In a closed unit the intensive care specialist takes on the senior role where the patient's primary doctor now acts as a consultant. Other countries have open Intensive Care Units, where the primary doctor chooses to admit and generally makes the management decisions. There is increasingly strong evidence that 'closed' Intensive Care Units staffed by Intensivists provide better outcomes for patients.[2][3]


History of Intensive Care Medicine

Florence Nightingale Era

The ICU's roots can be traced back to the Monitoring Unit of critical patients through nurse Florence Nightingale. In 1854 the Crimean War, in which England, France and Turkey declared war on Russia began. Because of the lack of critical care and the high rate of infection, there was a high mortality rate of hospitalized soldiers, reaching as high as 40% of the deaths recorded during the war. Florence and 38 other volunteers had to leave for the Fields of Scurati, and took their "critical care protocol" with them. Upon arriving, and practicing, the mortality rate fell to 2%. Respected and adored, Florence became an important decision maker, and became a (medical?) reference for the combatants during the war. However, Scurati had its downfall, and Nightingale contracted typhoid, and became physically disabled. Because of the extent of her injuries, she eventually returned in 1856 from the war. Florence Nightingale, OM, RRC (12 May 1820 – 13 August 1910), who came to be known as The Lady with the Lamp, was a pioneer of modern nursing, and a noted statistician. ...


Because of her physical disability, a School of Nursing was formed in 1859 in England dedicated to her. The School was recognized for it's professional value and technical caliber, receiving prizes throughout the English government. The School of Nursing was established in Saint Thomas Hospital, as a one year course, and was given to doctors. It utilized theoretical and practical lessons, as opposed to purely academic lessons. Florence died on August 13, 1910, leaving behind a legacy of persistence, capacity, compassion and devotion. Her work established the lines of direction and way for modern nursing, and at the same time paved the way for Intensive Care Medicine.


Dandy Era

Walter Edward Dandy was born in Sedalia, Missouri. He received his BA in 1907 through the University of Missouri and his M.D. in 1910 through the Johns Hopkins University School of Medicine. Dandy worked one year with Dr. Harvey Cushing in the Hunterian Laboratory of Johns Hopkins before entering its boarding school and residence in the Johns Hopkins Hospital. He worked in the Johns Hopkins College in 1914 and remained there until his death in 1946. One of the most important contributions he made for neurosurgery was the air method in ventriculography, in which the cerebrospinal fluid is substituted with air to help an image form on an X-Ray of the ventricular space in the brain. This technique was extremely successful for identifying brain injuries. Dr. Dandy was also a pioneer in the advances in operations for illnesses of the brain affecting the glossopharyngeal as well as Meniere's syndrome, and he published studies that show that high activity can cause sciatic pain. Walter E. Dandy (born Walter Edward Dandy 1886 in Sedalia, Missouri; died 1946) was an American neurosurgeon. ... Sedalia is a city located in Pettis County, Missouri, at the intersection of U.S. Highway 50 and U.S. Highway 65. ... The University of Missouri System is the designated public research and land-grant university system of the state of Missouri. ...


Safar Era

Peter Safar, the first Intensivist doctor, was born in Austria. He was the son of two doctors, who migrated to the United States after being in a Nazi concentration camp. The doctor first got certification as an anesthetist, and in the 1950's he started and praised the "Urgency & Emergency" room setup (now known as an ICU). It was at this time the ABC's (Airway, Breathing, and Circulation) protocols were formed, and artificial ventilation as well as external cardiac massage became popular. These experiments counted on volunteers of its team which only used minimum sedation. It was through these experiments that the techniques for maintaining life in the critical patient were established. Peter Safar was an Austrian physician of Czech descent, born April 12, 1924 in Vienna (Austria), died August 2, 2003 in Mt. ... An anesthesiologist (American English), or anaesthetist (British English), is a medical doctor trained to administer anesthesia. ... A medical ventilator is a device designed to provide mechanical ventilation to a patient. ...


In the city of Baltimore, the first surgical ICU was established, and in 1962, in the University of Pittsburgh, the first Critical Care Residency was established in the United States. It was around this time that the induction of hypothermia in critical patients was also tested.


More recently, the World Association for Disaster and Emergency Medicine was formed, and so was the SCCM (Society of Critical Care Medicine).


References

  • Intensive Care Medicine by Irwin and Rippe
  • The ICU Book by Marino
  • Procedures and Techniques in Intensive Care Medicine by Irwin and Rippe
  • Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med 2004;32:1254-9. PMID 15187502.

History Reference: Douglas Ferrari - Brazil [1] Brazilian Society of Intensive Care - SOBRATI : [2] [3]


See also

A newborn infant sleeping in his incubator. ... An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ...

External links

  • Critical Care On-Line Journal Club (via JournalReview.org)
  • Veterinary Emergency And Critical Care Society
  • Society of Critical Care Medicine

Notes

  1. ^ Kahn JM, Goss CH, Heagerty PJ, Kramer AA, O'Brien CR, Rubenfeld GD. (2006). "Hospital volume and the outcomes of mechanical ventilation.". New England Journal of Medicine 355 (1): 41-50. Retrieved on 2006-08-02. 
  2. ^ Manthous CA, Amoateng-Adjepong Y, al-Kharrat T, Jacob B, Alnuaimat HM, Chatila W, Hall JB. (1997). "Effects of a medical intensivist on patient care in a community teaching hospital." (Abstract). Mayo Clinic Proceedings 72 (5): 391-9. Retrieved on 2006-09-02. 
  3. ^ Hanson CW 3rd, Deutschman CS, Anderson HL 3rd, Reilly PM, Behringer EC, Schwab CW, Price J. (1999). "Effects of an organized critical care service on outcomes and resource utilization: a cohort study." (Abstract). Critical Care Medicine 27 (2): 270-4. Retrieved on 2006-09-02. 

  Results from FactBites:
 
Intensive Care | NYU Department of Medicine (748 words)
Intensive care experiences occur in Bellevue Hospital, Tisch Hospital, and the VA Medical Center.
With the exception of the intensive care unit at Bellevue, all units are staffed by a team of three second- or third-year residents and four interns.
Formalized care plans are coordinated with the managing intensivist for each case and a wide variety of formal conferences further supplement the education experience.
INTENSIVE CARE - The specialty and its specialists (3861 words)
As Intensive Care is multidisciplinary, and crosses the traditional boundaries of medical speciality groups, its practitioners must have a knowledge of some parts of these traditional specialities that is at least the equal of, and preferably superior to that of individuals from those specialities.
Indeed, the application of evidence based medicine to both the time honoured and innovative techniques and therapies used in intensive care is a major challenge for the future as inappropriate therapies applied in intensive care units prolong dying and suffering are expensive and may deny access to the unit to more appropriate patients.
The intensive care unit must not be isolationist but participate fully in the activities of other hospital groups and be represented in their clinical, administrative, research, and teaching activities.
  More results at FactBites »

 
 

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