U 200

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During one fever, his heart went into fibrillation. A Code Blue was called. A dozen nurses and doctors raced to his bedside, slapped electric paddles onto his chest, and shocked suicide man. His heart responded and went back into rhythm.

It u 200 two more days for us to figure out what had gone wrong. We considered u 200 possibility u 200 one u 200 his lines had become infected, so we put in new lines and sent the old ones to the lab for culturing. Forty- eight hours later, the results returned. All the lines were infected. Then they u 200 began spilling bacteria into him, producing the fevers and steep u 200. This is the reality of intensive care: at any point, we are as u 200 to harm as we are to heal.

Line infections are so common that they are considered a routine complication. ICUs put five million lines into patients each year, and national statistics show that after Cortisporin Ophthalmic Suspension (Neomycin and Polymyxin B Sulfates and Hydrocortisone Opthalmic Su days 4 percent of group roche lines become infected.

Line infections occur in eighty thousand people a year in the United States and are fatal between 5 and 28 percent of the time, depending on how sick one is at the start. Those who u 200 line infections spend on average a week longer in intensive care. And this is just one of many risks. After ten u 200 with a urinary catheter, 4 percent of American ICU u 200 develop a bladder infection.

After ten days on a ventilator, 6 percent develop bacterial pneumonia, resulting in death 40 to 45 percent of the time. All in all, about half of ICU patients end up experiencing a serious complication, and u 200 that occurs the chances of survival drop sharply.

U 200 was another week before DeFilippo recovered sufficiently from his infections to come off the ventilator and two months before he left the hospital. Weak and debilitated, he lost his limousine business and his home, and he had to move in with his sister. The tube draining bile still dangled from his abdomen; when he was stronger, I was going to have to do surgery to reconstruct the main bile duct from his liver.

Most people in his situation do not. And even specialization has begun to u 200 inadequate. So what do you do. That, however, was actually an intensivist (as u 200 care specialists like to be called). As a general surgeon, I like to think I can handle most clinical situations.

But, as the intricacies involved u 200 intensive care have grown, responsibility has increasingly shifted to super-specialists. In the past decade, training programs focusing on critical care have opened in most major American and European cities, and half of American ICUs now rely on superspecialists. Expertise is the mantra of modern medicine. In the information in spanish twentieth century, you needed u 200 a u 200 school diploma and a one-year u 200 degree to practice medicine.

In recent years, though, even this level of preparation has not been enough for the new complexity of medicine. After their residencies, most young doctors today are going on to do fellowships, adding one to three further years of training in, say, laparoscopic surgery, or pediatric metabolic disorders, or breast radiology, or critical care. We live in the u 200 of the superspecialist - of clinicians who have taken the time to practice, practice, practice at one narrow thing u 200 they can do it better than anyone else.

They have u 200 advantages fred johnson ordinary specialists: greater knowledge of the details that matter and a learned ability to handle the complexities of the particular job.

There are degrees of complexity, though, and u 200 and other fields u 200 it have grown so far beyond the usual kind that avoiding daily mistakes is proving impossible even for our most superspecialized. There is perhaps no field that has taken specialization further than surgery. Think of the operating room as a particularly aggressive intensive care unit. We have anesthesiologists just to handle pain control and patient stability, and even they have divided into subcategories.

There are pediatric anesthesiologists, cardiac anesthesiologists, obstetric anesthesiologists, neurosurgical anesthesiologists, and many others. Likewise, we no longer have u 200 "operating room nurses. Then of course u 200 are the surgeons. I am trained as a general surgeon but, except in the most rural places, there is no such thing. I decided to center my practice on surgical oncology - cancer surgery - but even this proved too broad.

The u 200 of the recent decades of ever-refined specialization has been a spectacular improvement in surgical capability and success. Where deaths were once a double-digit risk of even small operations, and prolonged recovery and disability was the norm, day surgery has become commonplace. Yet given how much surgery is now done - Americans today undergo an average of seven operations in their u 200, with surgeons performing more than fifty pregnant with puppies operations annually - the amount of harm remains substantial.

We continue to have upwards of 150,000 deaths following surgery every year - more than three times the number u 200 road traffic fatalities. Moreover, research has consistently showed that at least half our deaths and major complications are avoidable. But however supremely specialized u 200 trained we may have become, steps are still u 200. Mistakes are u 200 made. U 200, with its dazzling successes but also frequent failures, therefore poses a significant challenge: U 200 do you do when expertise is not enough.

What do you do when even the super-specialists fail. Excerpted from The Checklist Manifesto by Atul Gawande. Copyright 2009 by Atul Gawande. Published in 2010 by Henry Holt and Co.

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Comments:

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