Introduction to Critical Care
Critical care medicine is the multidisciplinary healthcare specialty that cares for patients with acute, life-threatening illness or injury (SCCM definition)
History of Critical Care
Patrick Neligan delineates the reasons a patient may need to be In a Critical Care Unit (http://ccmtutorials.com)
- Patients admitted to intensive care for intensive monitoring, in anticipation of possible aggressive interventions: this is the coronary care model.
- Patients admitted to units which act as extensions of the post-operative recovery room, allowing abnormal perioperative physiology to reverse, with or without modulation of the normal stress response. Post operative cardiac care is an example of this model.
- Patients who require very intense nursing care, which would not be available elsewhere: an example of this is a burns unit.
- Patients who do not necessarily require life sustaining treatments, but whose physiology is taken under control in order to prevent organ injury: neurosurgical critical care.
- Patients who have minimal physiologic reserve, and who undergo acute potentially reversible injury, requiring life support until the abnormalities have been reversed and reserve restored: this is the archetypical medical intensive care patient (COPD with pneumonia requiring mechanical ventilation).
- Patients who undergo an massive disruption to their physiology, due to an overwhelming stress response to injury, or inadequate compensation to the response: this is the patient frequently seen in surgical intensive care units major trauma or sepsis such as pancreatitis.
Critical Illness is all about physiologic reserve: its loss and our attempts to restore it or at least halt its deterioration
neuroendocrine exhaustion after prolonged critical illness
Patients are admitted because they have or will have one of the following derangements requiring intensive monitoring or intervention (Neligan):
Deteriorating Level of Consciousness or Coma
Fluid or Electrolyte Imbalance, including renal dysfunction
Cost effectiveness of critical care (Crit Care Med 2006;34:2738)
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