On 7 December 1988, a severe earthquake hit in Armenia, a former republic of the Soviet Union (USSR); on 11 September 2001, a manmade attack of similar impact hit New York City. These events share similar implications for the role of the uninjured survivor. With basic training, the uninjured survivors could save lives without tools or resuscitation… (More)
The Scalable Integration Model for Objective Resource Capability Evaluations (SIM-FORCE) provides Air Force decision-makers with a tool to evaluate potential actions and analyze expected results. The model evaluates the impact of schedule changes or resource availability on mission completion. It is a desktop tool that will support a wide variety of… (More)
Contemporary intensive care unit (ICU) medicine has complicated the issue of what constitutes death in a life support environment. Not only is the distinction between sapient life and prolongation of vital signs blurred but the concept of death itself has been made more complex. The demand for organs to facilitate transplantation promotes a strong incentive… (More)
The modern intensive care unit (ICU) has evolved into an area where mortality and morbidity can be reduced by identification of unexpected hemodynamic and ventilatory decompensations before long-term problems result. Because intensive care physicians are caring for an increasingly heterogeneous population of patients, the indications for aggressive… (More)
A moribund and debilitated patient arrives in an emergency department and is placed on life support systems. Subsequently it is determined that she has a 'living will' proscribing aggressive measures should her condition be judged 'terminal' by her physicians. But, as our round table of authorities reveal, the concept of 'terminal' means different things to… (More)
Agitation in the ICU: part two. Life threatening agitation, pathophysiology and effective treatment will appear in a future issue.
THE CASE The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on… (More)
The Gulf Coast Disaster of September 2005 has changed the entire paradigm of how we view public health. Our previous visions of disaster relief were predicated on the premise that the most effective after care would involve treating the direct effects of catastrophic, unpredicted trauma. Survivors would be readily amenable to first aid at the scene,… (More)
Highly complex and specialized care plans sometimes overwhelm the comprehension of patients and families. Many optimistic surrogates of critically ill patients err on the side of desiring that everything be done but with a nebulous idea of what 'everything' entails. Physicians must work closely to educate surrogates as to the benefits versus the risks of… (More)
When patients or their families rarely request inappropriate end of life care in the ICU for capricious reasons. End of life treatment decisions that only prolong discomfort and death are usually emotional and based on unrealistic expectations. I explore some of those reasons in this paper.