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Mastering the cognitive knowledge within a field such as critical care is a formidable task. It is even more difficult to draw on that knowledge, procure and filter through the clinical and laboratory data, develop a differential diagnosis, and, finally, to make a rational treatment plan. In critical care, a detailed understanding of hemodynamics, cardiovascular and pulmonary medicine, and pharmacology are important. Sometimes, it is prudent to initiate therapy for significant derangements rather than finding out the precise underlying disorder. For instance, in a patient with respiratory failure, therapy to increase oxygenation and ventilation is initiated while simultaneously determining the etiology. It is done through a more precise understanding of the pathophysiology that allows for rational and directed therapy. The critical care setting does not allow for much error. A skilled critical care physician must be able to quickly assess the patient's situation and produce an efficient diagnostic and therapeutic plan.
These skills the student learns best at the bedside, guided and instructed by experienced teachers, and inspired toward self-directed, diligent reading. Clearly, there is no replacement for education at the bedside, especially because in “real life,” delay in correct management leads to suboptimal outcome. Unfortunately, clinical situations usually do not encompass the breadth of the specialty. Perhaps the best alternative is a carefully crafted patient case designed to stimulate the clinical approach and the decision-making process. In an attempt to achieve that goal, we have constructed a collection of clinical vignettes to teach diagnostic and therapeutic approaches relevant to critical care medicine.
Most importantly, the explanations for the cases emphasize the mechanisms and underlying principles, rather than merely providing rote questions and answers. This book is organized for versatility; it allows the student “in a rush” to go quickly through the scenarios and check the corresponding answers, and it allows the student who wants thought-provoking explanations to obtain them. The answers are arranged from simple to complex: the bare answers, an analysis of the case, an approach to the pertinent topic, a comprehension test at the end, clinical pearls for emphasis, and a list of references for further reading. The clinical vignettes are placed in a systematic order to better allow students to gain an understanding of the pathophysiology and mechanisms of disease. A listing of cases is included in Section III to aid the student who desires to test his/her knowledge of a certain area, or to review a topic, including basic definitions. Finally, we intentionally did not use a multiple-choice question format in the opening case scenarios because clues (or distractions) are not available in the real world.