Critical Care Emergencies
Foreword Critical Care Emergencies
Amal Mattu, MD, FAAEM, FACEP Consulting Editor
Although critical care medicine has always been a significant part of the specialty of emergency medicine, its practice in the Emergency Department (ED) has never been as prevalent before as it is today. There are several reasons for this evolving change. First, overcrowding continues to be a pervasive and increasing problem in EDs throughout the United States as well as numerous other countries. As a result, critically ill patients are boarded in the ED, awaiting beds in intensive care units that are already filled, and care of these boarded patients falls on emergency care providers. Another reason for the increase in critical care practice in the ED is related to the aging population. First-world countries around the world are reporting a steady increase in their geriatric population, and those patients are bringing their acute medical needs to the ED in increasing numbers. Because of their multiple comorbidities, they tend to have more complicated disease and arrive much sicker than their younger counterparts. A third consideration is that the national increase in outpatient clinics and urgent care centers is pulling the less sick patients away from EDs, leaving a relative increase in critically ill patients in the EDs. These are only just a few of the reasons for the increase in critical care medicine being practiced in the ED. The increased need for emergency care providers to have a sound knowledge in critical care medicine is now well-recognized. Educational conferences in emergency medicine have increased the amount of teaching that is dedicated to caring for the critically ill. In fact, there are many new conferences over the past five years that have arisen that are focused specifically on teaching critical care to emergency physicians. Many critical care ultrasound and critical care procedures courses have been developed. New textbooks focused on critical care-emergency medicine have been published. Residencies in emergency medicine are increasing their critical care training and ICU rotations, and the number of emergency physicians doing fellowships in critical care has skyrocketed in recent years. Drs Evie Marcolini and Haney Mallemat have now stepped forward by providing an issue of Emergency Medicine Clinics of North America that is sure to be recognized as
Emerg Med Clin N Am 32 (2014) xv–xvi http://dx.doi.org/10.1016/j.emc.2014.09.002 0733-8627/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
emed.theclinics.com
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Foreword
another invaluable, cutting-edge resource for emergency health care providers that are interested in increasing their critical care knowledge and skills. Both of these guest editors are emergency physicians that have obtained additional fellowship training and board certification in critical care. They intimately know the challenges of caring for all of these types of critically ill patients in the ED. Drs Marcolini and Mallemat have created a list of topics that are pertinent to ED providers caring for critically ill patients, and they have assembled an outstanding group of authors to discuss the topics. Authors include physicians experienced in all aspects of critical care—medical, surgical, neurologic, and trauma. They address bread-andbutter topics such as the approach to shock, approach to trauma and neurotrauma, sepsis, pressors and inotropes, ventilator management, antimicrobials, and pediatric critical care. They also cover more in-depth “hot” topics such as managing coagulopathies, critical care ultrasound, lung-protective ventilation strategies, and advanced techniques in assessment of volume status and hemodynamics. Throughout all of the articles, however, they go beyond the basics and address recent advances and controversies. This issue of Emergency Medicine Clinics of North America is an invaluable addition to emergency medicine education. This issue should be considered must-reading not only for practicing emergency physicians but also for emergency medicine trainees and for any other health care providers that are responsible for caring for critically ill patients. Knowledge and practice of the concepts that are discussed in the following pages are certain to save lives. Our sincere thanks go to the guest editors and the authors for their time and commitment to this important issue. Amal Mattu, MD, FAAEM, FACEP Department of Emergency Medicine University of Maryland School of Medicine Baltimore, MD 21201, USA E-mail address: [email protected]
Foreword Critical Care Emergencies
Amal Mattu, MD, FAAEM, FACEP Consulting Editor
Although critical care medicine has always been a significant part of the specialty of emergency medicine, its practice in the Emergency Department (ED) has never been as prevalent before as it is today. There are several reasons for this evolving change. First, overcrowding continues to be a pervasive and increasing problem in EDs throughout the United States as well as numerous other countries. As a result, critically ill patients are boarded in the ED, awaiting beds in intensive care units that are already filled, and care of these boarded patients falls on emergency care providers. Another reason for the increase in critical care practice in the ED is related to the aging population. First-world countries around the world are reporting a steady increase in their geriatric population, and those patients are bringing their acute medical needs to the ED in increasing numbers. Because of their multiple comorbidities, they tend to have more complicated disease and arrive much sicker than their younger counterparts. A third consideration is that the national increase in outpatient clinics and urgent care centers is pulling the less sick patients away from EDs, leaving a relative increase in critically ill patients in the EDs. These are only just a few of the reasons for the increase in critical care medicine being practiced in the ED. The increased need for emergency care providers to have a sound knowledge in critical care medicine is now well-recognized. Educational conferences in emergency medicine have increased the amount of teaching that is dedicated to caring for the critically ill. In fact, there are many new conferences over the past five years that have arisen that are focused specifically on teaching critical care to emergency physicians. Many critical care ultrasound and critical care procedures courses have been developed. New textbooks focused on critical care-emergency medicine have been published. Residencies in emergency medicine are increasing their critical care training and ICU rotations, and the number of emergency physicians doing fellowships in critical care has skyrocketed in recent years. Drs Evie Marcolini and Haney Mallemat have now stepped forward by providing an issue of Emergency Medicine Clinics of North America that is sure to be recognized as
Emerg Med Clin N Am 32 (2014) xv–xvi http://dx.doi.org/10.1016/j.emc.2014.09.002 0733-8627/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
emed.theclinics.com
xvi
Foreword
another invaluable, cutting-edge resource for emergency health care providers that are interested in increasing their critical care knowledge and skills. Both of these guest editors are emergency physicians that have obtained additional fellowship training and board certification in critical care. They intimately know the challenges of caring for all of these types of critically ill patients in the ED. Drs Marcolini and Mallemat have created a list of topics that are pertinent to ED providers caring for critically ill patients, and they have assembled an outstanding group of authors to discuss the topics. Authors include physicians experienced in all aspects of critical care—medical, surgical, neurologic, and trauma. They address bread-andbutter topics such as the approach to shock, approach to trauma and neurotrauma, sepsis, pressors and inotropes, ventilator management, antimicrobials, and pediatric critical care. They also cover more in-depth “hot” topics such as managing coagulopathies, critical care ultrasound, lung-protective ventilation strategies, and advanced techniques in assessment of volume status and hemodynamics. Throughout all of the articles, however, they go beyond the basics and address recent advances and controversies. This issue of Emergency Medicine Clinics of North America is an invaluable addition to emergency medicine education. This issue should be considered must-reading not only for practicing emergency physicians but also for emergency medicine trainees and for any other health care providers that are responsible for caring for critically ill patients. Knowledge and practice of the concepts that are discussed in the following pages are certain to save lives. Our sincere thanks go to the guest editors and the authors for their time and commitment to this important issue. Amal Mattu, MD, FAAEM, FACEP Department of Emergency Medicine University of Maryland School of Medicine Baltimore, MD 21201, USA E-mail address: [email protected]
