摘要:

A Therapeutic Intervention Scoring System (TISS) is presented to allow quantitative comparison of patient care and research experiences of different intensive care units. 57 items of therapeutic intervention are scored on a one to four basis according to intensity of involvement. The points acquired per patient per 24 hours are summated by an experienced observer. TISS has been used to: 1) determine appropriate utilization of intensive care facilities at the Massachusetts General Hospital; 2) provide information on nurse staffing ratios for various patient care areas; 3) quantitatively validate a clinical classification of critically ill patients into four categories, thereby simplifying and organizing activities relating to patient care; 4) analyze cost of intensive care relative to the extent of care offered. Assumptions inherent in formulating this system are discussed. If other intensivists incorporate this system into their experience, meaningful comparisons between intensive care units can occur.

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

A prognostic classification system was developed to help define overall therapeutic goals in critically ill patients with rapidly changing clinical status, in order: a) to force the conscious decision as to use or omission of heroic measures (including cardiopulmonary resuscitation); b) to promote dialogue between the primary physician, ICU staff and the family with respect to the treatment goals and likelihood of success; c) to prevent confusion in those charged with the overall care of the ICU; d) to encourage the development of a treatment plan based on a frequent reassessment of the patient which does not ask the ICU staff to render extraordinary care to a patient who has no reasonable hope for survival as a person; e) to minimize the medical legal risks; f) to dignify the entire ICU operation for the patient, his family, and the staff; and most importantly, g) to guarantee continual reassessment of each individual case with respect to the goals of treatment and the determination of that point in time when treatment should be stopped, when the goals are no longer attainable.

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

The highly-developed and long-established Soviet Emergency Medical System (Skoraya Meditsinskaya Pomosch) is described on the basis of personal experience of the authors.Emphasis is placed on the areas where the Soviet system seems superior to those that are only now emerging in the United States. These include: early EMS career choice; EMS generalization followed by EMS specialization; use of geographically-dispersed emergency hospitals; a highly organized communication net (Centropunct); efficient and liberal use of highly-trained EMS paramedical personnel; national standards and policy established by the central government with latitude for operational implementation at a local level.The difficult problem of professional relationship between EMS physicians and their in-patient hospital specialty colleagues is partially solved in the Soviet Union by established emergency hospitals—a system not traditional in the United States.

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

This study was designed to observe the effect of movement on ill, injured, or shocked animals. Lightly-anesthetized dogs were subjected to hemorrhagic shock. Ambulance transport was simulated by shaking, jolting, and rocking a table in three axes as well as lifting and dropping it. Accelerometer readings compared well with previously reported readings in ambulances. Simulated transport caused a rise in blood pressure and cardiac output in five of the six dogs, with no change in heart rate or right atrial pressure. A 15° head-up tilt caused a marked fall in blood pressure and cardiac output in two of the six dogs, leading to asystole in one. This could be related to diminished venous return from the lower body. Intermittent positive pressure ventilation had no protective action.

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

摘要:

“Weaning” a patient from ventilatory assistance ranges from a simple to an extremely complex process. Certain general factors should be optimized before weaning is initiated. Included would be the correction of anemia, low cardiac output, fluid imbalance, arrhythmias, fever, electrolyte abnormalities, infection, and acid-base disturbances.Specific respiratory physiologic parameters should be evaluated. Tests indicative of adequate mechanical capability to allow weaning include: vital capacity greater than 10–15 ml/kg; forced expiratory volume in one second of greater than 10 ml/kg; peak inspiratory pressure of −20 to −30 cm H2O; spontaneous resting minute ventilation less than 10 L/min (which can be doubled with a maximal voluntary ventilation maneuver). Tests indicative of adequate oxygenation capability include: an AaDo2on 100% oxygen of less than 300–350 torr; a shunt of less than 10–20%; dead space to tidal volume ratio of less than .55 or .6.By following the guidelines reviewed in this discussion of techniques of respirator weaning, the majority of patients can readily be weaned from a respirator without complication.

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1974

数据来源: OVID