Critical Care

What is critical care?

Critical care is medical care for people who have life-threatening injuries and illnesses. It usually takes place in an intensive care unit (ICU). A team of specially-trained health care providers gives you 24-hour care. This includes using machines to constantly monitor your vital signs. It also usually involves giving you specialized treatments.

Who needs critical care?

You need critical care if you have a life-threatening illness or injury, such as:

• Severe burns
• COVID-19
• Heart attack
• Heart failure
• Kidney failure
• People recovering from certain major surgeries
• Respiratory failure
• Sepsis
• Severe bleeding
• Serious infections
• Serious injuries, such as from car crashes, falls, and shootings
• Shock
• Stroke

What happens in a critical care unit?

In a critical care unit, health care providers use lots of different equipment, including:

• Catheters, flexible tubes used to get fluids into the body or to drain fluids from the body
• Dialysis machines ("artificial kidneys") for people with kidney failure
• Feeding tubes, which give you nutritional support
• Intravenous (IV) tubes to give you fluids and medicines
• Machines which check your vital signs and display them on monitors
• Oxygen therapy to give you extra oxygen to breathe in
• Tracheostomy tubes, which are breathing tubes. The tube is placed in a surgically made hole that goes through the front of the neck and into the windpipe.
• Ventilators (breathing machines), which move air in and out of your lungs. This is for people who have respiratory failure.

These machines can help keep you alive, but many of them can also raise your risk of infection.

Sometimes people in a critical care unit are not able to communicate. It's important that you have an advance directive in place. This can help your health care providers and family members make important decisions, including end-of-life decisions, if you are not able to make them.

Croup

Croup is an inflammation of the vocal cords (larynx) and windpipe (trachea). It causes difficulty breathing, a barking cough, and a hoarse voice. The cause is usually a virus, often parainfluenza virus. Other causes include allergies and reflux.

Croup often starts out like a cold. But then the vocal cords and windpipe become swollen, causing the hoarseness and the cough. There may also be a fever and high-pitched noisy sounds when breathing. The symptoms are usually worse at night, and last for about three to five days. Children between the ages of 6 months and 3 years have the highest risk of getting croup. They may also have more severe symptoms. Croup is more common in the fall and winter.

Most cases of viral croup are mild and can be treated at home. Rarely, croup can become serious and interfere with your child's breathing. If you are worried about your child's breathing, call your health care provider right away.

Depression

What is depression?

Depression is more than a feeling of being sad or irritable for a few days. It's a serious mood disorder. As one of the most common mental disorders in the United States, depression can affect how you think, feel, and your everyday life. You may not know why you feel this way, but even basic daily activities such as sleeping, eating, or working may become difficult. Depression often needs long-term treatment but getting help at the earliest sign of a problem can help manage your symptoms.

What are the different types of depression?

The most common types of depression are major depression and persistent depressive disorder.

• Major depression symptoms include a depressed mood or a loss of interest. Symptoms affect your daily activities and last for at least two weeks.
• Persistent depressive disorder (also called dysthymia or dysthymic disorder) has less severe depressive symptoms, but they last longer, usually for at least two years.

Other types of depression can include:

• Seasonal affective disorder comes and goes with the seasons. It usually starts in late fall and early winter and goes away during the spring and summer.
• Bipolar disorder is sometimes called manic depression. This mood disorder can cause intense mood swings.
• Depression with symptoms of psychosis is a severe form of depression that also has delusions (false beliefs) or hallucinations (seeing, hearing, or feeling something that isn't there).

What causes depression?

There are a variety of things that may cause depression, including genetic, biological, environmental, and psychological factors. Depression can happen at any age and can affect anyone, but it's more common in women. This is often due to the physical and hormonal changes that women have during menstruation, pregnancy, the postpartum period, and menopause. Other mental disorders or chronic medical conditions such as diabetes, cancer, or heart disease may occur with depression. This may make the chronic condition or depression worse.

In some cases, there is no clear cause for depression.

Who is at risk of depression?

You may be at a higher risk of depression if you have a close relative who has it or another mental health disorder. Going through trauma or stressful life events may raise your risk even more.

What are the symptoms of depression?

Depression doesn't look the same on everyone. The type and number of symptoms of depression can vary and don't always appear like sadness. Depression may affect you differently based on your:

• Age. The symptoms of depression may be different in a child, who may appear more irritable than sad. Teens may act out or have excessive sleepiness. The symptoms for an older adult may not be as obvious as other age groups.
• Sex. Men often show symptoms and coping behaviors differently than women. Rather than sad, men may appear angry or irritable.
• Medical conditions. Some medicines and medical conditions may cause symptoms that look like depression. Chronic conditions may make depression worse.

Symptoms of depression are ongoing and affect your day-to-day life. They can include:

• Feeling sad or "empty"
• Losing interest in favorite activities
• Overeating, or not wanting to eat at all
• Sleeping too much, or not enough
• Feeling very tired
• Feeling hopeless, irritable, anxious, or guilty
• Having aches and pains, headaches, cramps, or digestive problems
• Having thoughts of death or suicide
• Changing moods or behaviors
• Increasing use of alcohol or drugs
• Isolating from family and friends

How is depression diagnosed?

If you think you have depression, talk to your health care provider or a mental health provider. To be diagnosed with depression, your provider may use many tools:

• A medical history will include asking about your symptoms and family history. To be diagnosed with depression, your symptoms must occur most of the day, nearly every day, for at least two weeks. One of the symptoms must be a depressed mood or a loss of interest in most activities.
• Medical tests may be done to rule out other medical conditions. Certain medicines and medical conditions (such as viruses or thyroid disorders) may cause symptoms like depression.
• A physical exam to make sure another issue isn't causing your symptoms.
• A mental health evaluation by your provider or a mental health provider.

What are the treatments for depression?

Depression may need long-term treatment. Most treatments include medicines and/or psychotherapy (talk therapy):

• Medicines such as antidepressants may help control your symptoms. You may need to try several medicines to find which works best for you. Medicine may take time to work and can have side effects. Don't stop taking your medicine without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicine.
• Psychotherapy (talk therapy) under the care of a mental health provider can help you recognize and change troubling emotions, thoughts, and behaviors. This may be done one-on-one or in a group setting. It can give you and your family support, education, skills, and coping strategies.
• Light therapy has been shown to be effective for seasonal affective disorder (SAD).
• Other treatments options may be considered if treatment isn't working or if depression is severe. These may include:
  • Electroconvulsive therapy (ECT) is a brain stimulation procedure that uses a mild electric current when you are under general anesthesia. ECT is most often used for severe depression that is not getting better with other treatments.
  • Repetitive transcranial magnetic stimulation (rTMS) is a brain stimulation procedure that uses magnetic waves to relieve depression. It's not as powerful as ECT, but with rTMS, you don't need anesthesia. It also has a low risk of negative effects on your memory and thinking.

Can depression be prevented?

Most cases of depression can't be prevented, but healthy lifestyle changes can have long-term benefits for your mental health. These can include:

• Getting regular exercise
• Having a consistent sleep schedule
• Controlling stress

If you, or someone you love is depressed, see your provider or a mental health provider. It's important to get treatment at the earliest sign of a problem.

If you or someone you know has thoughts of hurting themselves or attempting suicide, get help right away. If it is an emergency, dial 911.

NIH: National Institute of Mental Health

Dislocated Shoulder

What is a dislocated shoulder?

Your shoulder joint is made up of three bones: your collarbone, your shoulder blade, and your upper arm bone. The top of your upper arm bone is shaped like a ball. This ball fits into a cuplike socket in your shoulder blade. A shoulder dislocation is an injury that happens when the ball pops out of your socket. A dislocation may be partial, where the ball is only partially out of the socket. It can also be a full dislocation, where the ball is completely out of the socket.

What causes a dislocated shoulder?

Your shoulders are the most movable joints in your body. They are also the most commonly dislocated joints.

The most common causes of shoulder dislocations are:

• Sports injuries
• Accidents, including traffic accidents
• Falling on your shoulder or outstretched arm
• Seizures and electric shocks, which can cause muscle contractions that pull the arm out of place

Who is at risk for a dislocated shoulder?

A dislocated shoulder can happen to anyone, but they are more common in young men, who are more often involved in sports and other physical activities. Older adults, especially women, are also at higher risk because they are more likely to fall.

What are the symptoms of a dislocated shoulder?

The symptoms of a dislocated shoulder include:

• Severe shoulder pain
• Swelling and bruising of your shoulder or upper arm
• Numbness and/or weakness in your arm, neck, hand, or fingers
• Trouble moving your arm
• Your arm seems to be out of place
• Muscle spasms in your shoulder

If you are having these symptoms, get medical treatment right away.

How is a dislocated shoulder diagnosed?

To make a diagnosis, your health care provider will take a medical history and examine your shoulder. Your provider may also ask you to get an x-ray to confirm the diagnosis.

What are the treatments for a dislocated shoulder?

The treatment for dislocated shoulder usually involves three steps:

• The first step is a closed reduction, a procedure in which your health care provider puts the ball of your upper arm back into the socket. You may first get medicine to relieve the pain and relax your shoulder muscles. Once the joint is back in place, the severe pain should end.
• The second step is wearing a sling or other device to keep your shoulder in place. You will wear it for a few days to several weeks.
• The third step is rehabilitation, once the pain and swelling have improved. You will do exercises to improve your range of motion and strengthen your muscles.

You may need surgery if you injure the tissues or nerves around the shoulder or if you get repeated dislocations.

A dislocation can make your shoulder unstable. When that happens, it takes less force to dislocate it. This means that there is a higher risk of it happening again. Your health care provider may ask you to continue doing some exercises to prevent another dislocation.

Dislocations

Dislocations are joint injuries that force the ends of your bones out of position. The cause is often a fall or a blow, sometimes from playing a contact sport. You can dislocate your ankles, knees, shoulders, hips, elbows and jaw. You can also dislocate your finger and toe joints. Dislocated joints often are swollen, very painful and visibly out of place. You may not be able to move it.

A dislocated joint is an emergency. If you have one, seek medical attention. Treatment depends on which joint you dislocate and the severity of the injury. It might include manipulations to reposition your bones, medicine, a splint or sling, and rehabilitation. When properly repositioned, a joint will usually function and move normally again in a few weeks. Once you dislocate a shoulder or kneecap, you are more likely to dislocate it again. Wearing protective gear during sports may help prevent dislocations.