Critical Care Emergencies
Preface Critical Care
Evie Marcolini, MD Haney Mallemat, MD Editors
Emergency medicine physicians have been practicing critical care in the emergency department ever since our specialty was recognized more than 40 years ago. We are no strangers to critically ill patients, and we are trained to resuscitate and stabilize the sickest of them. Because of the exceptional care we are able to provide to critically ill patients, we have gained recognition and respect within the critical care community, including opportunities to become fellowship trained with board certification through the specialties of internal medicine, surgery, anesthesia, and neurology. The prevalence of critically ill patients in the emergency department population is on the rise. Several factors are contributing to this increase, including the aging of the population, our access to more advanced technology, and, subsequently, the complexity of patients’ presentations (eg, following organ transplantation or insertion of a left ventricular assist device). In addition, constraints on the health care system are limiting the number of available ICU beds, forcing critically ill patients to remain in the emergency department for extended periods of time. Therefore, emergency physicians have had to become experts in delivering complex care that once was traditionally managed “upstairs” in the ICU (eg., weaning patients from ventilators and providing palliative care). Like emergency medicine, critical care is a constantly evolving specialty with a rapidly advancing literature and continuous technological advancements. Emergency medicine physicians must change with the times and keep up with the new knowledge in this field. The most recent Emergency Medicine Clinics of North America issue devoted to critical care was published in 2008. During the 6 years since then, much has changed. Our goals for this Emergency Medicine Clinics of North America issue were to cover the “bread and butter” of critical care delivered in the emergency department as well as to update you on recent changes in the field that will enhance your practice. This issue presents articles on assessing fluid responsiveness, the use of ultrasound during initial resuscitation and evaluation, providing cardiopulmonary mechanical support, and helping patients and families address end-of-life issues.
Emerg Med Clin N Am 32 (2014) xvii–xviii http://dx.doi.org/10.1016/j.emc.2014.09.001 0733-8627/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
emed.theclinics.com
xviii
Preface
We are grateful to the highly qualified authors whose hard work has created an outstanding Emergency Medicine Clinics of North America issue that we hope will serve as a critical care reference for emergency physicians. We also thank the consulting editor, Dr Amal Mattu, for giving us the opportunity to edit this issue of Emergency Medicine Clinics of North America. We are very proud of this issue, and we hope you will learn as much from it as we did during the editing process. Evie Marcolini, MD Divisions of Neurocritical Care and Emergency Neurology and Surgical Critical Care Departments of Emergency Medicine and Neurology Yale University School of Medicine 464 Congress St. Suite 260 New Haven, CT 06519, USA Haney Mallemat, MD University of Maryland School of Medicine 110 South Paca Street, 6th Floor, Suite 200 Baltimore, MD 21201, USA E-mail addresses: [email protected] (E. Marcolini) [email protected] (H. Mallemat)
Preface Critical Care
Evie Marcolini, MD Haney Mallemat, MD Editors
Emergency medicine physicians have been practicing critical care in the emergency department ever since our specialty was recognized more than 40 years ago. We are no strangers to critically ill patients, and we are trained to resuscitate and stabilize the sickest of them. Because of the exceptional care we are able to provide to critically ill patients, we have gained recognition and respect within the critical care community, including opportunities to become fellowship trained with board certification through the specialties of internal medicine, surgery, anesthesia, and neurology. The prevalence of critically ill patients in the emergency department population is on the rise. Several factors are contributing to this increase, including the aging of the population, our access to more advanced technology, and, subsequently, the complexity of patients’ presentations (eg, following organ transplantation or insertion of a left ventricular assist device). In addition, constraints on the health care system are limiting the number of available ICU beds, forcing critically ill patients to remain in the emergency department for extended periods of time. Therefore, emergency physicians have had to become experts in delivering complex care that once was traditionally managed “upstairs” in the ICU (eg., weaning patients from ventilators and providing palliative care). Like emergency medicine, critical care is a constantly evolving specialty with a rapidly advancing literature and continuous technological advancements. Emergency medicine physicians must change with the times and keep up with the new knowledge in this field. The most recent Emergency Medicine Clinics of North America issue devoted to critical care was published in 2008. During the 6 years since then, much has changed. Our goals for this Emergency Medicine Clinics of North America issue were to cover the “bread and butter” of critical care delivered in the emergency department as well as to update you on recent changes in the field that will enhance your practice. This issue presents articles on assessing fluid responsiveness, the use of ultrasound during initial resuscitation and evaluation, providing cardiopulmonary mechanical support, and helping patients and families address end-of-life issues.
Emerg Med Clin N Am 32 (2014) xvii–xviii http://dx.doi.org/10.1016/j.emc.2014.09.001 0733-8627/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
emed.theclinics.com
xviii
Preface
We are grateful to the highly qualified authors whose hard work has created an outstanding Emergency Medicine Clinics of North America issue that we hope will serve as a critical care reference for emergency physicians. We also thank the consulting editor, Dr Amal Mattu, for giving us the opportunity to edit this issue of Emergency Medicine Clinics of North America. We are very proud of this issue, and we hope you will learn as much from it as we did during the editing process. Evie Marcolini, MD Divisions of Neurocritical Care and Emergency Neurology and Surgical Critical Care Departments of Emergency Medicine and Neurology Yale University School of Medicine 464 Congress St. Suite 260 New Haven, CT 06519, USA Haney Mallemat, MD University of Maryland School of Medicine 110 South Paca Street, 6th Floor, Suite 200 Baltimore, MD 21201, USA E-mail addresses: [email protected] (E. Marcolini) [email protected] (H. Mallemat)
