Heart & lung : the journal of critical care
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Adverse responses to protamine sulfate have been identified for many years. The antigen-antibody response to protamine sulfate results in a type I anaphylactic reaction. ⋯ Several potential risk factors for adverse reactions to protamine have been identified, including insulin-dependent diabetes mellitus, vasectomy, allergy to fish, prior exposure to protamine sulfate, and the rate of infusion. A case study is presented, and strategies for improving patient outcomes are discussed.
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The purpose of this study was to determine treatment times at a community hospital that does not receive prehospital electrocardiogram (ECG) transmission and to determine the effect of time to first hospital ECG on overall door-to-drug time. ⋯ While efficiency in obtaining a first hospital ECG on patients with suspected acute myocardial infarctions was achieved, this did not result in low door-to-drug times. Further streamlining of protocol and the exploration of prehospital initiatives may result in a significant reduction in door-to-drug times.
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Randomized Controlled Trial Clinical Trial
Effect of cardiopulmonary resuscitation training for parents of high-risk neonates on perceived anxiety, control, and burden.
⋯ CPR training is an important intervention for promoting a sense of control and reducing the anxiety and sense of burden experienced by parents of neonates at risk for cardiopulmonary arrest.
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Review Case Reports
Pulmonary embolism presenting as syncope: case report and review of the literature.
Syncope as an initial presentation of pulmonary embolism occurs in about 10% of patients. A 68-year-old woman was admitted to the hospital with syncope. A right lower lobe infiltrate was found on a chest x-ray film, and results of a ventilation-perfusion scan were interpreted to mean that a high probability of pulmonary embolism existed. ⋯ Syncope as a presenting symptom of pulmonary embolism is difficult to diagnose. Physicians must be vigilant with patients who have syncope, because this symptom may be the "forgotten sign" of life-threatening pulmonary embolism. The need for prompt diagnosis is clear, because with appropriate treatment the majority of patients may survive.
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Review
Monitoring neuromuscular blockade in the intensive care unit: the peripheral nerve stimulator.
Traditionally, neuromuscular blocking agents (NMBAs) have been administered in the operating room as an adjunct to anesthetics. Recent studies in the United States have indicated that 98% of the anesthesiologists and critical care nurses surveyed use NMBAs at least occasionally. ⋯ Understanding the complexities of NMBAs and the absolute need for accurate monitoring techniques is imperative for clinicians. The purpose of this literature review is to evaluate current literature regarding monitoring techniques of NMBAs and to guide the advanced practice nurse's role in critical care.