Critical care nursing quarterly
-
Severe sepsis and septic shock affect more than 700,000 people annually and represent approximately $17 billion annually in health care costs. Mortality in patients with 3 or more failed organs is up to 70%. ⋯ Health care providers must be knowledgeable in early identification and aggressive management. This case presentation outlines the components of care identified in the literature in the early and ongoing management of patients with severe sepsis and septic shock.
-
Boerhaave syndrome is a rarely occurring condition with a high mortality rate if not diagnosed in a timely manner. Patients with this condition complain primarily of chest pain, and practitioners should consider esophageal rupture as a differential diagnosis during the initial diagnostic evaluation. Most treatment modalities have been derived from case studies, as there are no published reports on randomized controlled trials specifically dedicated to the treatment of Boerhaave syndrome. This case presentation includes the pathophysiology of esophageal rupture and the management pathways that have been shown to be successful based on current literature.
-
Extracorporeal membrane oxygenation (ECMO) is a long-term extracorporeal support for critically ill patients with life-threatening compromises in cardiac and/or respiratory function. The unpredictability of ECMO resources for a large pediatric and adult population prompted a need for the ability to respond to significant fluctuations in the volume of patients on ECMO. ⋯ Combining the use of a centrifugal pump system with specialized and experienced cardiovascular intensive care nurses and the ECMO specialist team provided a milieu for education and training to support the new staffing model. The PCG ECMO model provides a safe, flexible, and fiscally responsible staffing model for variable ECMO activity.
-
Prone positioning has been used as a treatment option for patients with acute lung injury or acute respiratory distress syndrome (ARDS) since the early 1970s. Prone position and extended prone position ventilation have been shown to increase end-expiratory lung volume, alveolar recruitment, and oxygenation in patients with severe hypoxemic and acute respiratory failure. Prone positioning is not a benign procedure, and there are potential risks (complications) that can occur to both the patient and the health care worker. ⋯ Prone positioning is a viable, inexpensive therapy for the treatment of severe ARDS. This maneuver consistently improves systemic oxygenation in 70% to 80% of patients with ARDS. With the utilization of a standardized protocol and a trained and dedicated critical care staff, prone positioning can be performed safely.
-
Safety and quality improvement are major issues in children's hospitals. Improving pediatric medication safety often takes on a larger role in pediatric units than in adult units due to the larger size differences and dose ranges found in a pediatric intensive care unit. This article reviews the literature and our own experience at the CS Mott Children's Hospital, University of Michigan, to improve medication safety. The issues identified include (1) an effective pediatric medication safety governance structure within a larger hospital, (2) practice standardization strategies for physicians, nurses, and pharmacists, (3) use of pharmacy technicians as unit medication managers, which reduces medication costs and decreases nursing time spent hunting for medications, and (4) methods to improve the safety culture in a pediatric intensive care unit.