Critical care nursing quarterly
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Case Reports
Delayed onset of malignant hyperthermia in the intensive care unit: a rare but life-threatening disorder.
Malignant hyperthermia (MH) has been described as a rare inherited autosomal dominant metabolic syndrome triggered in patients after exposure to certain inhalation anesthetics and depolarizing muscle relaxants. Typically MH is seen within the operating room and postanesthesia care environment. This case study will discuss a patient with an atypical MH crisis in the intensive care unit. Pathophysiology, genetic basis of and testing for MH-susceptibility as well as the role of the critical care nurse in the management of this potentially fatal disorder will be discussed.
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Critically ill patients in the intensive care unit (ICU) who require mechanical ventilation often require continuous sedation infusions. These 2 interventions are associated with adverse outcomes such as increased duration of mechanical ventilation, increased length of stay in both the ICU and the hospital, and significant physiological and psychological complications. Daily sedation interruption (DSI) can reduce these adverse effects thereby improving long-term outcomes after critical illness. ⋯ DSI is safe, practical, cost-effective, and results in positive outcomes for patients; however, there are barriers to implementing and incorporating DSI into daily practice. Further research is required to provide additional evidence and promote more widespread utilization.
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Comparative Study Clinical Trial
Sleep monitoring by actigraphy in short-stay ICU patients.
Sleep deprivation is common in intensive care unit (ICU) patients. The criterion standard for sleep monitoring, polysomnography, is impractical in ICU. Actigraphy (a wrist watch indicating amount of sleep) proved to be a good alternative in non-ICU patients, but not in prolonged mechanically ventilated patients, probably due to ICU-acquired weakness. ⋯ The result showed that actigraphy underestimated the amount of wake time and overestimated the amount of sleep. The median specificity for actigraphy was always less than 19% and sensitivity more than 94%. Therefore, actigraphy is not reliable for sleep monitoring in short-stay ICU patients.
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This article reviews the institution of mock code simulation training to improve registered nurses responder performance at a trauma 1 teaching hospital. ⋯ Initial findings reveal that in-situ medical emergency team/code simulation followed by debriefing improved the performance of responders. We are currently offering the Five Alive program monthly during four 1-hour sessions and have found this program to be an effective training tool. There is one challenge to offering the program on the off shift and weekends. That is finding a time that is not too disruptive to patient care.