The management of patients in crisis is one of the greatest challenges that emergency

nurses and critical care nurses face every day. The initial focus of care always is directed

at lifesaving and limb-maintaining interventions. An immediate history of recent events

and underlying health problems is needed. This necessity is intertwined with the ongoing

assessment of the patient s condition. The emergency nurse and critical care nurse must

have an in-depth understanding of the pathophysiologic changes that occur during a

multitude of patient problems. The purpose of the first half of this issue of the Critical Care

Nursing~ Clinics OfNorth America is to provide an opportunity for understanding the perti nent

factors associated with the most common causes of sudden injury, illness, and deatb.

Each of the following articles includes a review of (1) the incidence of a specific problem;

(2) the identified cause of the problem; (3) pathophysiologic changes; (4) emergency inter

ventions taken; (4) nursing management of the situation; and (5) preventive strategies. We

have sought to present a wide range of clinical problems that will apply to all areas of

nursing practice.

The opening article by Patton and Pacetti deals with sudden cardiac death. This article

moves beyond the basic concepts frequently reviewed and highlights both the structure-

function and the electrogenie theory. Other issues reviewed include acute and chronic

lesions of the myocard ium, hypertrophy and cardiomyopathy, non-ischemic card iomyopa-

thies, sudden cardiac death, and congenital anomalies. The article by JaccJbs presents a

comprehensive review of neurologic events using a generic approach before focusing on

specific medical and traumatic conditions that are encountered frequently. Assessment of

the patient is emphasized in this article along with the medical and nursing interventions

required for the effective management of these critical events.

Rescorl s article discusses concepts surrounding environmental emergencies, with atten-

tion to the ability to withstand heat, cold, electrical energy, and eaten or-injected toxins.

The best defense against injury is prevention, it is important to lea rn about the environment

where one plans to live, work, or play, with an awareness of the habits and habitats of

the animals in one s surroundings. Pediatric emergencies are described by Vernon-I~evett,

noting that they encompass a wide range of illnesses with similarities and differences.

This article addresses only the most common illnesses seen in children, organizing them

according to organ systems and common final pathways within a system. Pediatric emer-

gencies tend to progress very rapidly, but they usually are treated readily with accurate

assessment and rapid intervention.

A review" of sudden infant death syndrome is given by O Donnell and Gaedeke. This

syndrome is the leading cause of death of infants in the United States between 1 month

and I year of age. |he environmental and maternal risk factors contimle to be evaluated

further to identity infants at risk and to develop prevention strategies. The anguish associ-

ated with sudden infant death syndrome cannot be expressed adequately and must be

included in any discussion of it. Keenarfs article focuses on the role of nursing assessment

of traumatic events in sudden illness, injury, and death. The critical component of this

role is patient assessment. The primary and secondary surveys of trauma assessment offer

the nurse a systematic method of assessing trauma patients not only for injuries, but also

fur the development of potential complications. The trauma nurse plays a critical role in

the assessment of the trauma patient. This assessment spans from the time of the patient s