Dimensions of critical care nursing : DCCN
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Census fluctuations and the failure to develop appropriate guidelines for admitting and transferring patients have made the staffing of critical care units extremely difficult, sometimes with serious ethical and physical consequences to patients. In this report, a case is analyzed to explore some of the ramifications of the use of beds in the critical care unit.
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Sodium bicarbonate has been deleted from the advanced cardiac life support protocol. Sodium bicarbonate is no longer endorsed as the method of choice for the management of metabolic acidosis in the early rounds of cardiopulmonary resuscitation. This paper discusses mechanisms of acidosis occurring during cardiopulmonary arrest, past and present protocols for sodium bicarbonate administration and rationale for the deletion of sodium bicarbonate from resuscitation protocols.
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Epidural catheters are now beginning to be used to manage pain in the critically ill child. Effective use of epidural catheters and epidural analgesics is a critical care nursing challenge.
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With the persistent presence of violence in our urban areas and the availability of guns, penetrating injuries as a result of firearm use continue to be a challenge for the emergency, surgery, and operating room nurse. Because gunshot wounds may be rapidly fatal, an understanding of firearms and the injuries they produce, as well as their possible complications, can assist the critical care nurse in caring for patients with gunshot wounds to the chest. Thoracic trauma is present in 50% of all trauma patients and is the cause of death in 25% of these victims. Penetrating trauma from violent episodes accounts for approximately 50% of cases of chest trauma in the urban setting.
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Hyperbaric nursing is a challenging new role for critical care nurses. The authors discuss this expanding career opportunity along with the science of hyperbaric oxygen (HBO) therapy, clinical uses, types of chambers, and steps toward developing this exciting nursing career.