Heart & lung : the journal of critical care
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The objective of this study was to review current changes in the pharmacologic management of cardiac arrest (ventricular fibrillation, pulseless ventricular tachycardia, asystole, and electromechanical dissociation) as put fourth by the American Heart Association's 1992 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. We concluded that the 1992 Guidelines provide a reference base for all clinicians involved in emergency cardiac care. The newly revised recommendations are classified on the basis of the true clinical merit of the intervention, for example, an intervention that has been proved effective (i.e., high-dose epinephrine) versus one that is possibly effective (i.e., high-dose epinephrine). ⋯ Magnesium sulfate has been added for the management of torsades de points, severe hypomagnesemia, or refractory ventricular fibrillation. The maximum total dose of atropine in the treatment of asystole and electromechanical dissociation has been increased from 2 mg to 0.04 mg/kg. The use of sodium bicarbonate should be limited to the treatment of hyperkalemia, tricyclic antidepressant overdose, overdoses requiring urinary alkalinization, or preexisting bicarbonate sensitive acidosis.
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Comparative Study
A comparison of resuscitation skills of qualified general nurses and ambulance nurses in The Netherlands.
To investigate the ability of qualified general nurses to perform cardiopulmonary resuscitation and to compare these skills with those of a group of ambulance nurses. ⋯ The practical skills in cardiopulmonary resuscitation are insufficient in the majority of this sample of general nurses in The Netherlands. The findings of this study should be used as a base to design an optimal form and content of an educational re-instruction program. We expect that a considerable improvement could be achieved by more frequent cardiopulmonary resuscitation re-instruction.
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To demonstrate that home spirometry measurements are reliable and valid and can be used as part of a home measurement monitoring system by lung transplant recipients. ⋯ This evaluation demonstrated that home measurements are both reliable (i.e., repeatable) and valid when compared with the "gold standard" of the pulmonary function laboratory. The home monitoring program has been well accepted by patients, is easy to use, and provides data comparable to that collected during clinic visits.
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To describe the clinical outcomes and cost for high-risk critical care patients with peripherally inserted central venous catheters (PICCs). ⋯ When subjects were in critical care areas, catheters remained in place a mean of 10 days with a range of one to 50 days. After patient transfer with catheters in place to acute care areas (medical-surgical units), convalescent units, and home care, catheters were maintained a mean of 13 days with a range of 1 to 116 days. Catheter days totaled 2069. The total number of catheter days while in critical care were 878, with 1191 catheter days after transfer to other areas. Seventy-one of the original 92 PICC catheters remained in place until treatment was completed or the patient expired. Twenty-one were removed for nonelective reasons. Of these patients, only one had significant morbidity related to sepsis. This septic episode occurred in a convalescent unit. Percentage of catheter-related sepsis was 0.48% per 1000 catheter days. Because PICCs are not used to any degree in critical care patients throughout the United States, this study should increase awareness among practitioners that this approach is a safe alternative method to chest or neck insertion for central venous access in high-risk critical care patients.