دانلود کتابچه راهنمای آکسفورد پزشکی مراقبت‌های ویژه

Critical care medicine is complex and exacting, yet exciting and fulfilling. It is truly holistic, covering every organ system, addressing the emotional as well as physical needs of the patient. It requires a broad knowledge base covering disease conditions, physiology and pathophysiology, biochemistry, pharmacology, and technology, including principles of engineering and physics. It also demands practical aptitude, excellent communication skills with colleagues, patients, and relatives, and the ability to work closely with and, if needs be, to lead a multidisciplinary team. Responses often have to be delivered in a time- critical manner in view of the many varied and stressful emergency situations that can arise, and these responses must be calm, considered, targeted, and— hopefully— successful. Regular legal, ethical, and life- and- death dilemmas must also be managed tactfully and appropriately. We are thus delighted to offer the fourth edition of this handbook. It has been considerably revised and updated since the last iteration. Many new sections have been added covering the wide gamut of therapeutic techniques and monitoring, drugs and fluids, specific organ system disorders and complications, and general management strategies. Non- clinical sections have also been enhanced. Ongoing controversies are highlighted and discussed. We fully acknowledge that many grey areas still remain in critical care practice where the evidence base is weak, conflicting, or non- existent. We offer our approach, fully acknowledging there are alternatives that may be as effective, or perhaps even more so. Many aspects of critical care management are changing; the multiple revisions in this new edition reflect this rapid evolutionary process. We have endeavoured to retain a succinct, concise, readable style that will continue to serve as a handy pocket/ web- based reference for both experienced and novice clinical staff from all disciplines. We trust that the framework provided herein represents sound clinical practice. We would, however, emphasize that patients are individuals and do not necessarily respond in an identical manner. It is thus crucial to recognize promptly how the illness is unfolding and to react accordingly, retaining flexibility of thought and action based on sound rationale and good practice. We gratefully acknowledge the input and advice received from Ronan Astin, Rob Bell, Mike Chapman, Gerry Christofi, Sam Clark, Perla Eleftheriou, Vanya Gant, David Graham, Neil MacDonald, Ruth Pepper, Claire Roddie, Naomi Ronan, Marie Scully, Rob Shulman, Helen Simpson, Ellie Singer, Steve Shepherd, Kai Keen Shui, David Wood, and PJ Zolfaghari. We would also like to thank Neil, Emma, Caitlin and Sandy MacDonald; Sue, Ellie and Josh Singer and Suzanne, Matthew, Adam, Tomas, James and Alex Webb, our families, who have helped and supported us to write this edition.