Science and Profession (Magill’s Medical Guide, Sixth Edition)
Critical care is the branch of medicine that provides immediate services, usually on an emergency basis. It also encompasses some forms of ongoing care provided in a hospital setting for patients who are so sick that they are medically unstable and must be monitored constantly. Such patients are at an ongoing high risk for disastrous complications.
Critical care personnel must be specially trained, and standards for training and evaluation in this field have been prepared for physicians, nurses, and other hospital personnel. Ninety percent of hospitals in the United States with fewer than two hundred beds have a single critical care unit, usually called an intensive care unit (ICU). Only 9 percent of these hospitals have a second intensive care facility, typically dedicated solely to the care of heart attack victims. In total, 7 to 8 percent of all hospital beds in the United States are used for intensive care. Because ICU facilities are at a premium and are expensive to operate, patients are transferred to a regular hospital bed as quickly as possible, given their specific medical condition. Of the physicians who are certified in critical care, most are anesthesiologists, followed by internists. A shortage of trained critical care physicians has existed in the United States for many years.
Critical care facilities are available in several varieties, providing specialized care to particular patients. The most...
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Diagnostic and Treatment Techniques (Magill’s Medical Guide, Sixth Edition)
Critical care is synonymous with immediate care: Swift action is required on an emergency basis to sustain or save a life. The most immediate of critical care needs are to establish and maintain a patent airway for ventilation and to maintain sufficient cardiac functioning to provide minimal perfusion or blood supply to critical organs of the body.
Resuscitation is the support of life by external means when the body is unable to maintain itself. Basic life support is for emergency situations and consists of delivering oxygen to the lungs, maintaining an airway, inflating the lungs if necessary, and assisting with circulation. These methods are collectively known as cardiopulmonary resuscitation (CPR). Oxygen can be transferred from one mouth to another by forceful breathing or by the means of pumps and pure oxygen from a container. The airway is commonly maintained by positioning the head and neck so as to extend the chin and open the trachea. It is also possible to make an incision in the trachea, insert a tube, and provide oxygen through the tube. The lungs may be inflated by using the force of exhaled air from one person breathing into another’s mouth or by utilizing a machine that inflates the lungs to a precise level and delivers oxygen in accurate, predetermined amounts. When a victim’s heart is not working, the circulation of blood is provided by external compression of the chest. This action...
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Perspective and Prospects (Magill’s Medical Guide, Sixth Edition)
One of the most important issues with regard to critical care is sometimes controversial: when to discontinue life support. Life-support equipment is usually withdrawn as soon as patients are able to function independent of the machinery. These patients continue to recover, are discharged from the hospital, and complete their recovery at home. For some, however, the outcome is not as positive. Machines may be used to assist breathing. For a patient who does not improve, or who deteriorates, there comes a point in time when a decision to stop life support must be made. This is not an easy decision, nor should it be made by a single individual.
The patient’s own wishes must be paramount. These wishes, however, must have been clearly communicated while the individual was in good health and had unimpaired thought processes. A patient’s family is entitled to provide input in the decision to terminate care, but others are also entitled to provide input: the patient’s physician, representatives of the hospital or institution, a representative of the patient’s religious faith, and the state.
Medical science has developed criteria for death. The application of these criteria, however, is not uniform. The final decision to terminate life support is frequently a consensus of all the parties mentioned above. When there is a dispute, the courts are often asked to intervene. Extensive disagreements exist concerning...
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For Further Information: (Magill’s Medical Guide, Sixth Edition)
Bongard, Frederick, and Darryl Y. Sue, eds. Current Critical Care Diagnosis and Treatment. 3d ed. New York: McGraw-Hill Medical, 2008. A medical text that combines medical and surgical perspectives with diagnostic and treatment knowledge. Covers forty topics in critical care basics, medical critical care, and essentials of surgical intensive care and includes information on pregnancy, psychiatric disorders, imaging procedures, and transport, among other topics.
Fink, Mitchell P., et al. Textbook of Critical Care. 5th ed. Philadelphia: Saunders/Elsevier, 2005. This medical text, written by experts in the field, represents the views of the Society of Critical Care Medicine. The general reader will find it interesting but may elect to skip some sections containing highly technical details.
Hogan, David E., and Jonathan L. Burstein. Disaster Medicine. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2007. Examines a wide range of relevant topics including natural, industrial, transportation, and conflict-related disasters; and infectious diseases, winter storms, fires and mass burn care, intentional chemical disasters, and mass shootings.
Markovchick, Vincent J., and Peter T. Pons. Emergency Medicine Secrets. 4th ed. Philadelphia: Mosby/Elsevier, 2006. A clinical reference book that covers decision making in emergency medicine, hematology and oncology, metabolism...
(The entire section is 278 words.)