Heart & lung : the journal of critical care
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Our purpose was to analyze hospital cost, resource utilization, and outcome by age for a large group of patients who required intensive care unit (ICU) services. Patients in the ICU (N = 6331) were stratified by age groups. Mean hospital cost per patient generally increased with age. ⋯ The current DRG hospital payment system appears to be inequitable for the patient who receives treatment in the ICU during the hospital stay. As hospital operating margins continue to decline because of federal and state DRG hospital payment systems, additional pressures may be applied for physicians, nurses, and health care professionals to cut expenses for these patients. In this effort to watch the bottom line, physicians and nurses must not sacrifice the quality of or the access to care for patients who require ICU services.
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Myocardial contusion after chest trauma remains one of the major complexities of trauma care today. Diagnostic methods such as 12-lead electrocardiography and echocardiography, as well as activity of the biochemical marker creatine kinase and the MB subfraction, have not been shown to be sensitive or specific indicators. We report a case of an intraoperatively proved myocardial contusion without creatinine kinase or creatine kinase MB elevation.
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Review
Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.
The administration of epidural and intrathecal narcotics is a technique of providing postoperative analgesia that is gaining popularity in many operating rooms, labor suites, and intensive care units. The epidural and intrathecal methods, first introduced a century ago, have been implemented as additional techniques for the administration of narcotic analgesics. Patients who have received epidural or intrathecal narcotics are frequently admitted to the intensive care unit for postoperative care. Because of their continuous proximity to the patient and their monitoring skills, critical care nurses are able to evaluate the analgesic effect and intervene in the event of a complication.
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Review Case Reports
Hypervolemic hemodilution: a new approach to subarachnoid hemorrhage.
Subarachnoid hemorrhage (SAH) refers to the sudden accumulation of blood in the subarachnoid space or in the ventricular system. The hemorrhage may occur with cerebral anomalies, tumors, or trauma. The presence of SAH has been associated with decreases in cerebral blood flow (CBF), which may be attributed in part to increased blood viscosity and hematocrit. ⋯ The dosage is gradually tapered before discontinuation. Effectiveness of the therapy is measured through improvement in neurologic function and regional CBF measurements. The critical care nurse plays a vital role in administering and monitoring the therapy and in educating the family about the disease process and interventions.
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Neurogenic pulmonary edema (NPE) is a serious complication associated with various central nervous system insults. Experimental and clinical data support the occurrence of pulmonary edema as a result of neurogenic factors. ⋯ The pathophysiology of this disease is not well understood. We discuss the current theories of NPE, its signs and symptoms, and the nursing management for patients with NPE.