Principles of Critical Care > Part I. An Overview of the Approach to and Organization of Critical Care > Chapter 1. An Approach to Critical Care Jesse B. Hall,Gregory A. Schmidt,Lawrence D. H. Wood

Key Points

"Intensive care has its roots in the resuscitation of dying patients. Exemplary critical care provides rapid therapeutic responses to failure of vital organ systems, utilizing standardized and effective protocols such as advanced cardiac life support and advanced trauma life support. Other critically ill patients in less urgent need of resuscitation are vulnerable to multiple organ system failure, and benefit from prevention or titrated care of each organ system dysfunction according to principles for reestablishing normal physiology. This critical care tempo differs from the time-honored rounding and prescription practiced by most internists and primary care physicians. Furthermore, the critical care physicians providing resuscitation and titrated care often have little first-hand familiarity with their patients' chronic health history, but extraordinary tools for noninvasive and invasive description and correction of their current pathophysiology. Though well prepared for providing cure of the acute life-threatening problems, the intensivist is frequently disappointed to be the bearer of bad news when recovery is impossible, and increasingly must develop and use compassionate pastoral skills to help comfort dying patients and their significant others, using clinical judgment to help them decide to forego further life-sustaining treatment. Accordingly, experienced intensivists develop ways to curb their inclination toward action in order to minimize complications of critical care, while organizing the delivery of critical care to integrate and coordinate the efforts of many team members to help minimize..."