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1、CHAPTER23SURGICALCRITICALCARECharlesA.Adams,Jr.,AndrewStephen,andWilliamG.Cioffimetabolicconditions,whereasexogenouscausescanincludecentralnervoussystemmedications,environmentalsettings,andtoxins.Anyunex-cardiovascularsystemplainedchangesinasurgicalpatient’slevelofconsciousnesso
2、rrespiratorysystemsensoriumshouldbeworkedupthoroughly.AscribingsuchgastrointestinalsystemchangestoICUpsychosisshouldbeconsideredstrictlyadiag-acutekidneyinjury1nosisofexclusion.ThetermalteredmentalstatusisnonspecifichepaticdysfunctionandmoredescriptivedefinitionswereofferedbyPlu
3、mandendocrinesystemPosneralmost30yearsagointheirtextonstuporandcomaandhematologicsystemstillapplytoday.Thetermconfusionencompassesbewilderment,sepsisandmultipleorganfailuredifficultyfollowingcommands,disturbedmemory,anddrowsi-nessornighttimeagitation,whereasdeliriumisafloridlyco
4、nclusionabnormalmentalstatecharacterizedbydisorientation,fear,irritability,misperceptionofsensorystimuliand,often,visualhallucinations.Thegoalofsurgicaltherapy,electiveorurgent,istoenableThepresenceofdeliriumcanhavefar-reachingconse-patientstoreturntotheirpreoperativestateofheal
5、thandfunc-quencesandisassociatedwithincreasedhospitallengthofstay2tionalstatus.However,somepatientshavesurgicalprocessesorandmortality.Obtundationisdefinedasmentalbluntingasso-injuriesthataresoseverethattheywouldeithernotsurviveorciatedwithslowedpsychologicalresponsestostimulati
6、on.wouldsuffersignificantlong-termmorbiditywithoutspecializedStuporisdescribedasaconditionofdeepsleeporbehaviorallysupportivecare.Thesetypesofpatientsrequiremultisystemsimilarunresponsivenessinwhichthepatientcanbearousedsurgicalcriticalcaredeliveredbyspecializedteamsoftrainedonl
7、ybyvigorousandrepeatedstimuli.Comaisastateofhealthcareprovidersinanintensivecareunit(ICU).AlthoughunarousablepsychologicalunresponsivenessinwhichthesubjectmanyoftheseICUsareclosedunitsorstructuredsothatpatientlieswitheyesclosedandshowsnopsychologicallyunderstand-managementdecisi
8、onsaremadesolelybythecriticalcareteam,ablerespo
