Critical care nursing quarterly
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Review
Toxicologic emergencies in the intensive care unit: management using reversal agents and antidotes.
To review the most common drugs implicated in overdoses admitted to the intensive care unit focusing on antidotes and reversal agents used in their management. ⋯ Understanding the most prevalent overdoses and their management using reversal agents and antidotes is essential to the overall treatment of these critically ill patients.
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Managing drug shortages has become a daily requirement for health care providers in the critical care environment. Drug shortages impact the practice of different disciplines in various ways, and the perceptions of the underlying causes and appropriate management of drug shortages vary among physicians, nurses, and pharmacists as well. Frequently, these differences can lead to tension between disciplines and feelings of frustration, anger, and helplessness. Understanding the reasons behind drug shortages, the role each discipline has in managing shortages, and establishment of an effective method of communication between disciplines is key to reducing the tension and frustration that can be associated with drug shortages.
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Multidrug-resistant gram-negative bacilli are emerging threats in the intensive care unit setting worldwide. Extended-spectrum β-lactamases, AmpC β-lactamases, and carbapenem-resistant Enterobacteriaceae are increasing at an alarming rate, leaving limited therapeutic options. In addition, multidrug resistance among Pseudomonas aeruginosa and Acinetobacter baumannii has widely disseminated and become a frequent cause of nosocomial infections within many intensive care units. ⋯ Some multidrug-resistant gram-negative bacteria remain susceptible to only a few antibiotics such as tigecycline, fosfomycin, and polymyxins. The steady trend of increasing resistance coupled with the lack of novel antibiotics targeting resistant gram-negative bacilli has forced clinicians to increasingly apply more aggressive dosing strategies, such as prolonged and continuous infusion of β-lactam antibiotics to address the challenges associated with these difficult-to-treat pathogens. Nurses who have a thorough understanding of antibiotic resistance patterns, infection control procedures, and appropriate antibiotic use and dosing regimens, particularly the method of administration, are essential in the battle to preserve the usefulness of antibiotics and prevent further antibiotic resistance.
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Agitation, pain, and delirium are focal points for targeted pharmacologic therapy in the intensive care unit. Understanding how to treat these essential entities necessitates fundamental understanding of the pharmacology of sedation, analgesia, and antipsychotics. Monitoring the effectiveness of these medications is crucial to optimize therapeutic outcomes and minimize untoward effects. ⋯ In addition to understanding pharmacologic principles associated with the treatment of agitation, pain, and delirium, familiarization with the plethora of assessment tools used to guide therapy in these critically ill patients is mandated. This review focuses on the pharmacology of therapeutic agents used for sedation, analgesia, delirium, and neuromuscular blockade. Significant focus is given to the various assessment tools often used in practice today.
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Intensive care unit (ICU) delirium is widespread and occurs in 20% to 80% of patients. It can be assessed with ICU-validated scoring tools. The most commonly used tools include the Confusion Assessment Method for the ICU and the Intensive Care Delirium Screening Checklist. ⋯ Risk factors include predisposing factors such as history of alcohol abuse, dementia, or hypertension and precipitating factors such as immobilization, oversedation, higher severity of illness, and use of certain psychoactive medications such as benzodiazepines. Pharmacologic treatment with atypical antipsychotics may be used to reduce the duration of delirium if prevention is not successful. However, because of the adverse effects associated with these treatments, close monitoring for side effects is warranted.