Initiation of a respiratory therapist-driven protocol for assessment and management of risk for respiratory complications in the study hospital's neurosurgery step-down, trauma/surgery step-down, and trauma/surgery general units was followed by an increase in the number of patients receiving respiratory treatments, but decreases in ICU and hospital stays and overall hospital costs.
This is the first of a two-part series on severe traumatic brain injury, focusing on the evidence for optimal care.
The Advanced Trauma Life Support (ATLS) course for doctors was introduced in Nebraska in 1978 and given nationally for the first time in 1980 by the American College of Surgeons. The goal of ATLS is to serve as a safe and reliable method for managing patients with traumatic injury and provide a "common baseline for the continued innovation and challenge of existing paradigms in trauma care."
Remember the principle of homeostasis from first-year physiology the idea that the human body has self-regulating processes to maintain a desirable internal state? What were we taught to do when disease disrupted the self-regulating processes, and physiologic parameters were abnormal? Use medical treatments to restore them to normal values. Well, now we know that this may not be the best way to enhance survival.
The introduction of telemedicine in the ICU dates to the 1980s when Grundy and colleagues reported results of an 18-month trial using interactive television to provide consultation between university-based critical care physicians and a small (7-bed) inner city ICU with no intensivist of its own.
