Triage and resuscitation of critically ill patients in the emergency department: current concepts and practice.
Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. The measurement of central venous blood oxygen saturation, arterial lactate concentration, cardiac output and systemic oxygen delivery and consumption can enhance the detection of the clinically occult cumulative oxygen debt in critically ill patients. Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.
Rady
M Y
MY
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, USA.
D016638:Critical Illness / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D008991:Monitoring, Physiologic; D017410:Practice Guidelines as Topic; D012151:Resuscitation / Q000379:methods*; D014218:Triage / Q000379:methods*; D014481:United States