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Cretical Care
What is Critical Care Medicine?
Critical Care Medicine or Intensive Care Medicine is a specialty of medicine concerned with the management of patients with life threatening, frequently complex medical and/or surgical conditions.  Critical care medicine is a relatively new but increasingly important medical specialty which takes a system by system approach to treatment.  Critical care involves close, constant attention by a team of specially-trained health professionals.  Critical care takes place in an intensive care unit (ICU) or coronary care unit (CCU).  Medical research has repeatedly demonstrated that critical care or ICU care provided by intensivists produces better outcomes and more cost effective care.  

What is an Intensivist?
Physicians who have training in critical care medicine are referred to as intensivists.  The specialty requires additional fellowship training for physicians who complete their primary residency training in internal medicine, anesthesiology, or surgery.  Dr. Badar and Dr. Tuazon are intensivists-physicians with a primary training in internal medicine who pursued combined fellowship training in pulmonary and critical care medicine. 

The intensivist coordinates the care provided to the critically ill patient with other medical or surgical specialists, as well as ancillary professionals such as dietary, respiratory therapy, and pharmacology.  The intensivist regularly meets with the patient and family to provide information regarding the patient's condition, diagnosis, support, required testing, treatments and prognosis.  With input from the patient (if the patient is able to participate in decision making) along with the family the intensivist makes sure the plan is consistent with the patient's previously stated or written wishes.

The following are links to Advance Directive or Living Will:
http://www.finance.cch.com/tools/downloads/texmeddirect.rtf
http://www.texashealth.org/body.cfm?id=139

The critically ill patients and the intensive care unit
Patients requiring critical or 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 effects of multiple organ system failure.  The patients have dysfunction or failure of one of more organ systems: cardiovascular, respiratory, central nervous system, renal (and metabolic), gastro-intestinal tract (and nutritional condition), microbiology (including sepsis status), endocrine, and hematology.  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. 
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.

Procedures used to help support and to help identify the cause of the critical illness include (but not limited to) central venous catheterization, pulmonary artery catheterization, arterial cannulation, thoracentesis, bronchoscopy, lumbar puncture, paracentesis, and chest tube thoracostomy.

For more information, please follow the link to the American Medical Association on Intensive Care Units:
http://jama.ama-assn.org/cgi/reprint/287/24/3326.pdf  (English)
http://jama.ama-assn.org/cgi/data/287/24/3326/DC1/1  (Spanish)


 

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