Critical care medicine deals with life-threatening disorders across multiple specialties. The initial cause might involve complications from surgery, an injury, or a severe medical illness, but the common factor is that the patient’s cardiopulmonary function is impaired or at significant risk. Such patients require close, constant care in a critical care unit by a specially trained team.
Critical Care Medicine
Critical Care Medicine Sections (A-Z)
Approach to the Critically Ill Patient
Critical care medicine specializes in caring for the most seriously ill patients. These patients are best treated in an ICU staffed by experienced personnel. Some hospitals maintain separate units for special populations (eg, cardiac, surgical, neurologic, pediatric, or neonatal patients). ICUs have a high nurse:patient ratio to provide the necessary high intensity of service, including treatment and monitoring of physiologic parameters.
Cardiac arrest is the cessation of cardiac mechanical activity resulting in the absence of circulating blood flow. Cardiac arrest stops blood from flowing to vital organs, depriving them of oxygen, and, if left untreated, results in death. Sudden cardiac arrest is the unexpected cessation of circulation within a short period of symptom onset (sometimes without warning). Sudden cardiac arrest occurs outside the hospital in about 400,000 people/yr in the US, with a > 90% mortality.
Respiratory Failure and Mechanical Ventilation
Respiratory failure is a life-threatening impairment of oxygenation, CO2 elimination, or both. Respiratory failure may occur because of impaired gas exchange, decreased ventilation, or both. Common manifestations include dyspnea, use of accessory muscles of respiration, tachypnea, tachycardia, diaphoresis, cyanosis, altered consciousness, and, without treatment, eventually obtundation, respiratory arrest, and death. Diagnosis is clinical, supplemented by ABGs and chest x-ray. Treatment is usually in an ICU and involves correction of the underlying cause, supplemental O2, control of secretions, and ventilatory assistance if needed.
Sepsis and Septic Shock
(see also Shock and Fluid Resuscitation.)
Shock and Fluid Resuscitation
(see also Sepsis and Septic Shock.)