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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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.
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The presence of family members during cardiopulmonary resuscitation (CPR) of an adult patient remains a contentious area of practice that has attracted wide international debate. However, the attitude and experience of Jordanian nurses concerning this area of practice are not known yet. ⋯ Before initiating hospital policy regarding the option of family presence during resuscitation, attitudes and experiences of patients and relatives on witnessed resuscitation should be explored. Also, educating nurses about the importance of practicing to have the presence of family members during CPR of adult patients should be considered.
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When the clinical picture of a patient in the intensive care unit necessitates placement of an artificial airway supported by mechanical ventilation, a regimen of sedation and analgesia is initiated with the goal of providing anxiolysis and pain control to facilitate ventilation and therapeutic and diagnostic intervention. However, some of the most commonly used sedative agents, such as benzodiazepines, may have profound long-term effects on patients' health, including neuropsychological functioning. With more patients now surviving intensive care, more patients are suffering from these negative health consequences. A review of recent research on the subject suggests that more novel, non-benzodiazepine agents such as dexmedetomidine, fluorinated ether gases, and remifentanil function effectively as sedative agents in intubated patients in the intensive care unit, and are less likely to lead to delirium, agitation, aggression, psychosis, and other complications; in addition, use of these alternatives is associated with shorter times to awakening, extubation, and ICU discharge, as well as shorter overall length of stay and decreased cost of care.
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The intensive care unit (ICU) provides a critical level of care to medically unstable patients. Patients need intensive monitoring and treatment that may require emergency interventions. The vulnerability and complexity of the ICU unintentionally creates an environment that limits and poorly defines the intervention of early mobility in the unstable critically ill patients. ⋯ Further research is necessary to establish and institute policies and protocols on early mobility programs in the ICU to direct patient care. The role of the clinical nurse specialist can contribute by conducting evidence-based research, educating health care providers and patients, and implementing protocols. The hope is to change the culture of the ICU for the better.