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M aintaining an optimal level of comfort and safety for critically ill patients is a universal goal for critical care practitioners. The American College of Critical Care Medicine (ACCM) of the Society of Critical Care Medicine's (SCCM's) practice parameters for the optimal use of sedatives and analgesics was published in 1995 and recommended a tiered(More)
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)
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 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)
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)
The decision to withdraw or withhold life supporting treatment in moribund patients is difficult under any circumstances. When the patient becomes incompetent to clarify their wishes regarding continued maintenance in long-term facilities, surrogates sometimes cannot agree, further clouding the issue. We examine a case where the State's interests come into(More)
Critical care medicine has expanded the envelope of debilitating disease through the application of an aggressive and invasive care plan, part of which is designed to identify and reverse organ dysfunction before it proceeds to organ failure. For a select patient population, this care plan has been remarkably successful. But because patient selection is(More)