AACN advanced critical care
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Review
ECG monitoring after cardiac surgery: postoperative atrial fibrillation and the atrial electrogram.
Atrial fibrillation is one of the most common complications after cardiac surgery and is associated with adverse outcomes such as increased mortality, neurological problems, longer hospitalizations, and increased cost of care. Major risk factors for the development of postoperative atrial fibrillation include older age and a history of atrial fibrillation. beta-Blockers are the most effective preventive therapy, although sotalol and amiodarone can also be used for prophylaxis. ⋯ Because an atrial electrogram records larger atrial activity than ventricular activity, it can be invaluable in establishing the diagnosis of postoperative atrial fibrillation. Once atrial fibrillation begins, treatment can be started with either rhythm conversion or rate-controlling medications.
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As professionals who care for the sickest children, we want to provide the best evidence-based care available. While there are questions still to be answered, it is clear that when propofol is administered to children, it should be done in a manner that is intentional, well planned, and consistent with national guidelines and regulatory groups. Haphazard administration of propofol will place children at risk.
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Hospitals, especially their intensive care units, are not particularly safe for patients. Life-threatening mistakes and omissions in care can and do occur. To deter omissions and mistakes wherever possible, our medical intensive care team developed a checklist of care issues that must be addressed daily for every patient in our intensive care unit. ⋯ It is too soon to tell whether the checklist has had an impact on our survival rate or length of stay, but we have documented clear improvement in our attention to these core intensive care issues. In addition, our team's collegiality and team bonding are enhanced by using an evidence-based tool to achieve our care goals. We share our checklist, so that others can use and/or adapt it in their pursuit of optimal care for their critically ill patients.
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The use of rapid response teams is a relatively new approach for decreasing or eliminating codes in acute care hospitals. Based on the principles of a code team for cardiac and/or respiratory arrest in non-critical care units, the rapid response teams have specially trained nursing, respiratory, and medical personnel to respond to calls from general care units to assess and manage decompensating or rapidly changing patients before their conditions escalate to a full code situation. This article describes the processes used to develop a rapid response team, clinical indicators for triggering a rapid response team call, topics addressed in an educational program for the rapid response team members, and methods for evaluating effectiveness of the rapid response team.
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There is growing evidence that control of hyperglycemia in the critically ill patient improves outcome. Normalizing blood glucose levels decreases the risk of developing sepsis, end-organ damage, and hospital mortality. ⋯ This article describes the effects of hyperglycemia and discusses the evidence supporting tight glycemic control in such patients. The necessary steps to implement an intensive insulin therapy protocol for control of acute hyperglycemia are detailed.