Critical care nurse
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Critical care nurse · Dec 2013
Case ReportsBrain death: assessment, controversy, and confounding factors.
When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. ⋯ Neurodiagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.
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Critical care nurse · Dec 2013
Permissive hypotension in bleeding trauma patients: helpful or not and when?
Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. ⋯ With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.
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Critical care nurse · Dec 2013
Evidence-based prevention of pressure ulcers in the intensive care unit.
The development of stage III or IV pressure ulcers is currently considered a never event. Critical care patients are at high risk for development of pressure ulcers because of the increased use of devices, hemodynamic instability, and the use of vasoactive medications. This article addresses risk factors, risk scales such as the Norden, Braden, Waterlow, and Jackson-Cubbin scales used to determine the risk of pressure ulcers in critical care patients, and prevention of device-related pressure ulcers in patients in the critical care unit.