الفهرس 
Evolution of the intensive care unit.Only 14 pages are availabe for public view
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Abstract
The ICU, now common place in hospitals evolved from three main sources, according to Hilberman. First was the postoperative recovery unit, the first of which was established for neurosurgical patients at the Johns Hopkins Hospital in Baltimore in 1923. This and other recovery units were the forerunners of today’s surgical ICUs (SICUs).The first medical ICUs (MICUs) were created primarily to care for patients with respiratory failure caused by poliomyelitis and other neuromuscular diseases. The first coronary care units (CCUs) were established in 1962 at Toronto General Hospital, Bethany Hospital in Kansas City, and Presbyterian Hospital in Philadelphia. Specialized units for neonatal and pediatric patients, patients with burns and neurosurgical problems, and patients recovering from heart surgery were developed after SICUs, MICUs, and CCUs were established.
The now more simplified CPR interventions were extended to the larger domain of both professional and lay rescuers. The first national guidelines for what to teach to whom and how, was published in 1966. Guidelines were also developed under the auspices of the World Federation of Societies of Anesthesiologists, which expanded guidelines for advanced life support, including cerebral resuscitation. In the decade that followed the first National Conference on Standards for CPR and Emergency Cardiac Care was organized under the auspices of the American Heart Association (AHA), which thereafter assumed increasing responsibility for professional leadership of the field, both nationally and later internationally. Major efforts to improve outcomes from sudden cardiac death were intended to keep pace with an increasing incidence of cardiac arrest in communities with a predominance of elderly patients with ischemic heart disease. Still, only 4% to 9% of victims of cardiac arrest survive, and the scope of this worldwide epidemic prompted increasing international concern among industrialized nations. After the 2000 International Conference on the science of resuscitation, conferences have been scheduled on an international basis every 5 years, and the recommendations serve as the basis of national guidelines that fulfill local needs. Yet, the emergence of well-trained rescue services have failed to continue to improve outcomes, except in unique public settings in which there is immediate access to CPR. It became apparent that CPR must be begun within less than 5 minutes.
A mechanical change of substantial importance in the late 1960’s and early 1970’s that shaped the present era was the introduction of Positive End Expiratory Pressure (PEEP). Two modes of ventilation Assisted Ventilation (AV) and Controlled Mechanical Ventilation (CMV) came together in a single piece of equipment and the modern era of multiple choice respiratory support was born. The introduction of Intermittent Mechanical Ventilation (IMV) permitted spontaneous respiration in the midst of substantial respiratory failure which paved the way for a means of weaning i.e. Synchronized Intermittent Mechanical Ventilation (SIMV). Pressure Support Ventilation ( PSV) proved to be an addition to IMV that facilitated spontaneously breathing patients. Today’s ventilators have evolved from simple mechanical devices into highly complex microprocessor controlled systems. Of late, resurgence in the popularity of noninvasive positive pressure breathing and the advent of high frequency positive pressure ventilation have further invigorated the area of mechanical ventilation. also unconventional modes of ventilation will be borne out in the near future.
The 2007 focused update of the AHA Practice Guidelines for treatment of ST segment elevation MI recommended emergency revascularization within 36 hours of onset of ST segment elevation MI complicated by CS in patients younger than 75 years of age
Pulmonary embolism (PE) remains a common and lethal entity that continues to diagnostically and therapeutically challenge contemporary physicians. As with many aspects of medicine, insights into the historical perspective of the disease are useful in configuring contemporary advances. Although enormous progress has been made in understanding the physiology of PE, developing new diagnostic modalities and strategies, and constant refinement in the use of heparin therapy and thrombolytic therapy, VTE remains a common and lethal process. As the history of this disease illustrates, advances continue to be made and it is anticipated that with newer diagnostic studies and anticoagulants under development, the diagnosis and treatment of PE will continue to improve
Antibiotics are chemicals produced by or derived from microorganisms. The first antibiotic was discovered by Alexander Fleming in 1928 in a significant breakthrough for medical science. The care of infections in the critically ill has made dramatic strides since the release of the first sulfonamide antibiotic, Prontosil in 1935. critical care medicine has moved beyond simply awaiting the arrival of the next antibiotic to one of improved use of existing agents to better cure disease and simultaneously minimize the expression of drug resistance. Early aggressive intervention, rapidly abbreviated courses of therapy, antibiotic combinations, and pharmacodynamically optimized dosing regimens are all activities directed toward retaining these agents in critical care for many years to come.
Solid organ transplantation is one of the most remarkable and dramatic therapeutic advances in medicine during the past 60 years. This field has progressed initially from what can accurately be termed a ‘‘clinical experiment’’ to routine and reliable practice, which has proven to be clinically effective, life-saving and cost-effective when compared with non transplantation management strategies of both chronic and acute end stage organ failures.This remarkable evolution stems from a serial confluence of: cultural acceptance; legal and political evolution to facilitate organ donation, procurement and allocation; technical and cognitive advances in organ preservation, surgery, immunology, immunosuppression; and management of infectious diseases
Healthcare professionals should consider ethical, legal, and cultural factors when caring for those in need of CPR. Although healthcare providers must play a role in resuscitation decision making, they should be guided by science, the individual patient or surrogate preferences, local policy, and legal requirements.