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January 1976

Preventing Ulcer Bleeding in Multiple Systems Failure

Arch Surg. 1976;111(1):93. doi:10.1001/archsurg.1976.01360190095026

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To the Editor.—I write concerning Dr Arthur Baue's excellent editorial, "Multiple, Progressive, or Sequential Systems Failure" (Arch Surg 110:779-781, 1975).

My comments concern the 14 suggested therapeutic options he describes to prevent multiple systems failure in postoperative and accidental trauma patients. I would add a simple and, I believe, empirically logical measure to his list. It pertains to minimizing stress ulcer bleeding—a common terminal event after decompensation of several organ systems. The group of patients under consideration are usually "tubed" (three orifices minimum), wired, ventilated, irrigated, and restrained in an intensive care unit where bright lights and constant monitor beeps stimulate the patient during his conscious periods. In this environment, I would hope that physician and nurse would mercifully administer frequent and adequate doses of morphine or similar analgesics for sleep and relaxation. Analgesia and sedation in this setting may well be equally important as nasogastric suction and antacids

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