Critical care medicine
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Critical care medicine · May 2007
Randomized Controlled Trial Comparative StudyVideo-based training increases sterile-technique compliance during central venous catheter insertion.
To evaluate the effect of an online training course containing video clips of central venous catheter insertions on compliance with sterile practice. ⋯ An online training course, with short video clips of actual patient care demonstrating noncompliant behaviors, improved sterile-practice compliance for central venous catheter insertion. Paper handouts with equivalent content did not improve compliance.
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Critical care medicine · May 2007
ReviewClinician-performed focused sonography for the resuscitation of trauma.
Traumatic death remains pandemic. The majority of preventable deaths occur early and are due to injuries or physiologic derangements in the airway, thoracoabdominal cavities, or brain. Ultrasound is a noninvasive and portable imaging modality that spans a spectrum between the physical examination and diagnostic imaging. ⋯ Although not as widely appreciated, the focused use of ultrasound may also have a role in detecting hemothoraces and pneumothoraces, guiding airway management, and detecting increased intracranial pressure. Intensivists generally utilize a treating philosophy that requires the real-time integration of many divergent sources of information regarding their patients' anatomy and physiology. They are therefore positioned to take advantage of focused resuscitative ultrasound, which offers immediate diagnostic information in the early care of the critically injured.
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Physicians spend a considerable amount of time and effort inserting catheters and needles into patients. Central venous catheters are the mainstay of measuring hemodynamic variables that cannot be assessed by noninvasive procedures. These catheters also allow hemodialysis, parenteral nutritional support, delivery of medications, and catecholamine administration. ⋯ With the development and refinement of portable and affordable high-resolution ultrasound devices, imaging vascular access has changed the role of the traditional landmark techniques. In this article, we explain the use of ultrasound for vascular access to reduce complications associated with cannulation of veins and arteries. We will also provide a brief overview of the current literature regarding ultrasound-guided vascular access.
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Critical care medicine · May 2007
Prediction of short-term and long-term outcomes after cardiac arrest: a prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations.
To determine the prognostic accuracy of biochemical, clinical, electrophysiological, and neuropsychological investigations in predicting outcomes after cardiac arrest. ⋯ A multivariate assessment approach should be used to establish an early high-certainty prognosis after cardiac arrest. However, further prospective clinical studies are necessary to confirm this derived predictor index. In addition, an early recording of S-100B, long-latency sensory-evoked potential, and neuropsychological bedside screening reflect a cognitive long-term outcome.
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Critical care medicine · May 2007
ReviewUltrasound-guided interventional radiology in critical care.
Ultrasound-guided intervention is becoming an increasingly popular and valuable tool in the critical care setting. In general, image-guided procedures can expedite wait times and increase the accuracy, safety, and efficacy of many procedures commonly performed within intensive care units. ⋯ These include central venous catheter deployment, thoracentesis, paracentesis, and drainage of a wide variety of abscesses, and percutaneous nephrostomy, percutaneous cholecystectomy, and inferior vena cava filter placement. Although we believe ultrasound is significantly underutilized in critical care today, we anticipate that with the improvement of ultrasound technology and the innovation of new ultrasound-guided procedures, the role of ultrasound in the intensive care unit will continue to expand, with bedside ultrasound-guided interventions increasingly becoming the norm.