AACN advanced critical care
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Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes-tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support-Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.
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Sepsis is the body's systemic response to infection that can be complicated by acute organ dysfunction and is associated with high mortality rates and adverse outcomes for acute and critically ill patients. The 2012 Surviving Sepsis Campaign guidelines advocated for implementation of evidence-based practice care for sepsis, with a focus on quality improvement. ⋯ Implementing performance improvement strategies aimed at early recognition and targeted treatment can further improve sepsis care and patient outcomes. This article presents an overview of the process of implementing performance improvement initiatives for sepsis care, highlighting the significant contribution of nursing care.
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Stroke is the fourth leading cause of death and the leading cause of significant, long-term disability in the United States. Clinicians' knowledge and use of evidence to guide the care of patients with ischemic stroke are paramount to improving patient outcomes. ⋯ The guideline provides 115 recommendations for the management of patients with acute ischemic stroke, including 24 new recommendations and 51 revised recommendations divided into 14 major topic areas. This article reviews the recommendations and related literature and provides suggestions for use and implementation of the guideline within a stroke program of care.
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The use of sedative and analgesic medications is directly linked to patient outcomes. The practice of administering as-needed sedative or analgesic medications deserves further exploration. We hypothesized that important variations exist in the practice of administering as-needed medications in the intensive care unit (ICU). We aimed to determine the influence of time of day on the practice of administering as-needed sedative or analgesic medications to children in the ICU. ⋯ We identified a pattern of increased administration of as-needed sedative or analgesic medications during nights. Further research is needed to identify the underlying causes of this practice variation.