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The development of modern intensive care units (ICUs) has allowed the survival of patients with advanced illness and injury, although at a cost of substantial infrastructure. Natural disasters and military operations are two common situations that can create critically ill patients in an environment that is austere or has been rendered austere. This has driven the development of two related strategies to care for these casualties. Portable ICU capability can be rapidly established in the area of need, providing relatively advanced capability but limited capacity and sustainability. The other strategy is to rapidly evacuate critically ill and injured patients following their initial stabilization. This permits medical personnel in the austere location to focus resources on a larger number of less critical patients. It also permits the most vulnerable patients to receive care in an advanced center. This strategy requires careful planning to overcome the constraints of the transport environment. The optimal strategy has not been determined, but a combination of these two approaches has been used in recent disasters and military operations and is promising. The critical care delivered in an austere setting must be integrated with a long-term plan to provide follow-on care.

Abstract The development of modern intensive care units (ICUs) has allowed the survival of patients with advanced illness and injury, although at a cost of substantial infrastructure. Natural disasters and military operations are two common situations that can create critically ill patients in an environment that is austere or has been rendered austere. This has driven the development of two related strategies to care for these casualties. Portable ICU capability can be rapidly established in the area of need, providing relatively advanced capability but limited capacity and sustainability. The other strategy is to rapidly evacuate critically ill and injured patients following their initial stabilization. This permits medical personnel in the austere location to focus resources on a larger number of less critical patients. It also permits the most vulnerable patients to receive care in an advanced center. This strategy requires careful planning to overcome the constraints of the transport environment. The optimal strategy has not been determined, but a combination of these two approaches has been used in recent disasters and military operations and is promising. The critical care delivered in an austere setting must be integrated with a long-term plan to provide follow-on care.

Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. These documents inform and shape patient care around the world. In this Perspective we discuss the importance of diversity on guideline panels ; the disproportionately low representation of women on critical care guideline panels, and existing initiatives to increase the representation of women in corporations, universities, and government. We propose five strategies to ensure gender parity within critical care medicine. ; American College of Emergency Physicians ; American Thoracic Society Assembly on Critical Care, Women in Critical Care Working Group ; American Thoracic Society-Health Equality and Diversity Committee ; Australia and New Zealand Intensive Care Society ; Canadian Critical Care Society ; Canadian Critical Care Trials Group ; German SepNet Critical Care Trials Group ; German Sepsis Society ; Global Sepsis Alliance ; International Forum for Acute Care Trialists (InFACT) ; Latin American Sepsis Institute ; Scandinavian Society of Anaesthesiology and Intensive Care Medicine ; George Institute for Global Health ; World Federation of Critical Care Nurses ; World Federation of Societies of Intensive and Critical Care Medicine ; Univ Toronto, Dept Med, Toronto, ON, Canada ; lnterdepartmental Div Crit Care Med, Toronto, ON, Canada ; Sinai Hlth Syst, Toronto, ON, Canada ; Univ Toronto, Lawrence S Bloomberg Fac Nursing, Toronto, ON, Canada ; Univ Toronto, Univ Hlth Network, Toronto, ON, Canada ; Canadian Crit Care Soc, Markham, ON, Canada ; St Michaels Hosp, lnterdepartmental Div Crit Care Med, Toronto, ON, Canada ; St Michaels Hosp, Dept Surg, Toronto, ON, Canada ; Li Ka Shing Knowledge Inst, Toronto, ON, Canada ; Univ Fed São Paulo, Anesthesiol Pain & Intens Care Dept, São Paulo, Brazil ; McMaster Univ, Hamilton Hlth Sci Thrombosis & Atherosclerosis Re, Hamilton, ON, Canada ; McMaster Univ, Dept Med, Hamilton, ON, Canada ; McMaster Univ, Clin Epidemiol & Biostat, Hamilton, ON, Canada ; McMaster Univ, Crit Care Med, Hamilton, ON, Canada ; Univ Calif San Francisco, Div Pulm Crit Care Allergy & Sleep Med, San Francisco, CA 94143 USA ; Univ Calif San Francisco, Cardiovasc Res Inst, San Francisco, CA USA ; Vanderbilt Univ, Sch Med, Dept Pathol Microbiol & Immunol, Nashville, TN 37212 USA ; Univ Colorado, Sch Med, Pulm Sci & Crit Care Med, Denver, CO USA ; Univ British Columbia, British Columbia Childrens Hosp, Dept Pediat, Vancouver, BC, Canada ; Univ Montreal, Hosp Ctr, Montreal, PQ, Canada ; Univ Montreal, Div Intens Care, Montreal, PQ, Canada ; George Inst Global Hlth, Div Crit Care & Trauma, Sydney, NSW, Australia ; Univ Sydney, Sydney, NSW, Australia ; Jena Univ Hosp, Ctr Sepsis Control & Care, Dept Anesthesiol & Intens Care, Jena, Germany ; Global Sepsis Alliance, Jena, Germany ; Imperial Coll London, Dept Paediat, Wellcome Trust Ctr Clin Trop Med, London, England ; Univ Vermont, Div Pulm & Crit Care Med, Burlington, VT USA ; Makerere Univ, Dept Anesthesia & Crit Care, Kampala, Uganda ; Inst Med Sci, Bombay Hosp, Dept Crit Care Med, Bombay, Maharashtra, India ; Univ Fattouma Bourguiba, Ctr Hosp, Monastir, Tunisia ; Oslo Univ Hosp, Scandinavian Soc Anaesthesiol & Intens Care Med, Oslo, Norway ; Oslo Univ Hosp, Dept Anaesthesiol, Oslo, Norway ; Tribhuvan Univ, Teaching Hosp, Dept Anaesthesiol, Kathmandu, Nepal ; Univ Fed São Paulo, Anesthesiol Pain & Intens Care Dept, São Paulo, Brazil ; Web of Science

The intensive care units in North West London are part of one of the oldest critical care networks in the UK, forming a mature and established strategic alliance to share resources, experience and knowledge for the benefit of its patients. North West London saw an early surge in COVID-19 admissions, which urgently threatened the capacity of some of its intensive care units even before the UK government announced lockdown. The pre-existing relationships and culture within the network allowed its members to unite and work rapidly to develop agile and innovative solutions, protecting any individual unit from becoming overwhelmed, and ultimately protecting its patients. Within a short 50-day period 223 patients were transferred within the network to distribute pressures. This unprecedented number of critical care transfers, combined with the creation of extra capacity and new pathways, allowed the region to continue to offer timely and unrationed access to critical care for all patients who would benefit from admission. This extraordinary response is a testament to the power and benefits of a regionally networked approach to critical care, and the lessons learned may benefit other healthcare providers, managers and policy makers, especially in regions currently facing new outbreaks of COVID-19.

Bangladesh became an independent and sovereign country in 1971 following a nine-month blood shedding liberation war. Bangladesh has a population of about 152.25 million, making it one of the most populous countries in the world. Intensive care is an emerging but less emphasized concept in Bangladesh. The first intensive care unit (ICU) in Bangladesh was established in the National Institute of Cardiovascular Diseases (NICVD) in 1980. Since then many ICUs have been established. In Bangladesh there is no governing body like Bangladesh Medical and Dental Council (BMDC) that can set the standard of such units. There are no reliable statistics regarding the number of both governmental and private ICUs, bed capacities, no. of patients getting admitted per month, services offered, equipment, qualification of health professionals, cost/benefits and mortality rates of these ICUs.

It is now widely recognized that the physical environment has an impact on the physiology, psychology, and sociology of those who experience it. When designing a critical care unit, the demands on the architect or designer working together with the interdisciplinary team of clinicians are highly specialized. Good design can have a hugely positive impact in terms of the recovery of patients and their hospital experience as a whole. Good design can also contribute to productivity and quality of the work experience for the staff. 'Design for Critical Care' presents a thorough and insightful gu

Improve your skills in visual diagnosis Speed and accuracy of diagnosis is the key to saving lives in emergency and critical care medicine. Careful visual inspection of the patient, the data (radiography, electrocardiogram), and related clues can often help providers choose the right diagnosis and ultimately the best treatment - but this knowledge comes with experience. This book provides 110 randomly presented visual diagnosis cases for self-testing, imitating real-life situations found in the emergency department setting. Written by distinguished emergency and critical care physicians, and thoroughly revised and updated throughout, this second edition includes 25% new cases and is an ideal aid for trainees preparing for Board examinations as well as an invaluable 'refresher' for qualified emergency and critical care providers.

Examining effective collaboration in critical care settings -- Assessing and addressing collaborative practice issues -- Collaboration with patients and family members -- Collaboratively identifying and addressing critical care delivery issues -- Developing and undertaking effective evaluation -- Concluding comments

Cover -- Half-title page -- Title page -- Copyright page -- Dedication -- Contents -- Foreword -- Contributors -- Section 1 Ultrasound fundamentals -- S1 Introduction -- Chapter 1 Physics and "knobology" -- Chapter 2 Getting started -- Chapter 3 Ultrasound in austere environments -- Section 2 Diagnostic ultrasound -- S2 Introduction -- Chapter 4 The extended focused assessment with sonography for trauma (E-FAST) -- Chapter 5 Focused cardiac ultrasound -- Chapter 6 Pulmonary ultrasound -- Chapter 7 Inferior vena cava, aorta assessment -- Chapter 8 HEENT (head, ears, eyes, nose, throat): ocular, sinus, neck ultrasound -- Chapter 9 Renal, bladder -- Chapter 10 The pediatric abdomen -- Chapter 11 Hepatobiliary -- Chapter 12 Male genitourinary: scrotal pain, swelling -- Chapter 13 Pelvic obstetrics -- Chapter 14 Pelvic: gynecology -- Section 3 Procedural ultrasound -- S3 Introduction -- Chapter 15 Vascular access -- Chapter 16 Bladder ultrasound for catheterization and suprapubic aspiration -- Chapter 17 Ultrasound-guided lumbar puncture -- Chapter 18 Soft tissue applications -- Chapter 19 Orthopedics: extremity fractures, reductions, and arthrocentesis -- Chapter 20 Peripheral nerve blocks -- Chapter 21 Pericardiocentesis, thoracentesis, and paracentesis -- Chapter 22 Cutting-edge procedures: the airway -- Section 4 Special populations -- S4 Introduction -- Chapter 23 Neonates and infants -- Chapter 24 The critically ill: respiratory and hemodynamic support -- Index.

The COVID-19 pandemic has caused an unprecedented challenge for the provision of critical care. Anticipating an unsustainable burden on the health service, the UK government introduced numerous legislative measures culminating in the Coronavirus Act, which interfere with existing legislation and rights. However, the existing standards and legal frameworks relevant to critical care clinicians are not extinguished but anticipated to adapt to a new context. This new context influences the standard of care that can be reasonably provided and yields numerous human rights considerations, for example in the use of restraints or the restrictions placed upon patients and visitors under the Infection Prevention and Control guidance. The changing landscape, has also highlighted previously unrecognised legal dilemmas. The perceived difficulties in the provision of PPE for employees pose a legal risk for trusts and a regulatory risk for clinicians. The spectre of rationing critical care poses a number of legal issues. Notably, the flux between clinical decisions based on best interests towards decisions explicitly based on resource considerations should be underpinned by an authoritative public policy decision to preserve legitimacy and lawfulness. Such a policy should be medically coherent, legally robust and ethically justified. The current crisis yields numerous challenges for clinicians aspiring to remain faithful to medico-legal and human rights principles developed over many decades, especially when such considerations could easily be dismissed. However, it is exactly at such times that these principles are needed the most and clinicians play a disproportionate role in safeguarding such principles for the most vulnerable.