Critical Care Medicine: Approach to Clinical Complications in Emergency Care and Practice

Principles and practice of emergency medicine and critical care are not just grounded on the basic tenets of "care"─ but more profoundly, on the meticulous understanding and management of every matters of clinical urgency. Critical care undertakes the care of an ailing patient who presents with life-threatening illnesses often compounded with serious (multi)organ dysfunctions. Beyond a human touch which is a prerequisite─ it also mandates diagnostic reasoning and clinical judgment skills to render any benefit to the critically-ill and indisposed patient. This often requires bringing forth the combined clinical decision-making abilities of several specialists which constitute a broad domain of clinical and emergency care. Essence of good critical care stems from several established protocols: e.g., early diagnosis, anticipation of possible complications, and foremost─ dynamic stabilization of the critically ill (hemodynamic stabilization, metabolic optimization, etc.). This paper in the foreground, intently looks at the approaches of the intensivists to a critical illness, and attempts to delineate about how they apply wisdom, skills, and 'intuitions' to cure─ as well as to gain a better perception of the matters of urgency in critical care medicine. While in the background, it reviews the rationale for understanding the management of complex clinical conditions characterized by shock─ which still remains an important cause of complications leading to organ failure and dysfunction that contributes to high degree of mortality in the ICU. Furthermore, this paper analyses the central protocol, prognostic factors and therapeutic interventions that are being followed to manage complications of shock or related severe syndromes (Disseminated intravascular coagulopathy). Finally, the paper discusses about what kind of marginal approaches exists or might be undertaken to break the gridlock of decision "freeze" if it occurs when the last few attempts to salvage a critically compromised patient with multi-organ dysfunction fails to save a life