Critical care nursing quarterly
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The use of knee-length versus thigh-length compression stockings and sequential compression devices.
Nurses on an Acute Care Evidence Based Practice Committee, creating a policy to increase patient compliance with thromboembolic deterrent stockings (TEDS) and sequential compression devices (SCDs) for deep vein thrombosis prophylaxis, found limited literature on patient preference and response to this treatment. ⋯ Knee-length TEDS and SCDs are more comfortable for patients, encourage higher levels of compliance with treatment, do not pose a risk for venous stasis to patients by creating restricting bands, and are less expensive. Patients need ongoing education to resume wearing TEDS and SCDs after activities of daily living, and knee-length stockings and devices would be easier to reapply. The policy in our institution was changed for the use of knee-length compression stockings and SCDs.
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Ventricular assist devices (VADs) play an increasingly important role in the care of cardiovascular patients. Developed initially for support of cardiothoracic surgery patients experiencing difficulty in weaning from cardiopulmonary bypass, these devices have been used extensively as a bridge to cardiac transplantation for patients who are failing on medical management. ⋯ Applications for VADs are expanding and advances in technology occurring to support these new applications. This article provides an overview of current and emerging VADs and nursing management of the VAD patient.
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Review Case Reports
Bringing research to the bedside: the role of induced hypothermia in cardiac arrest.
Despite progress in resuscitative practices, there has been little improvement in mortality and neurologic morbidity outcomes after cardiac arrest. Updated resuscitative guidelines were published in 2005, and included changes in resuscitation measures and recommendations in postresuscitation interventions including induced hypothermia. Treatment with induced hypothermia after cardiac arrest for up to 24 hours has been shown to significantly improve the neurologic outcomes and mortality in patients with primary cardiac arrest who remain comatose after return of spontaneous circulation. ⋯ A multidisciplinary team led by a neurointensivist was formed to develop and implement a protocol to support induced hypothermia after cardiac arrest. Twenty-five patients have received induced hypothermia with a 74% survival rate. Of those who survived, 47% went home for a regular discharge, 29% transferred to acute rehabilitation, and 23% transferred to a long-term care facility.
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Pharmacologic agents including vasodilators, inotropes, and vasopressors are frequently used in the critical care setting for management of the unstable cardiac patient. These medications are used to elicit varying effects on vascular resistance, myocardial contractility, and heart rate to help achieve desired hemodynamic and clinical endpoints. ⋯ This article reviews the pharmacology and clinical utility of commonly used intravenous "vasoactive" medications encountered in the intensive care unit. We also highlight innovations in pharmacotherapy for this patient population, and provide practical considerations for the most appropriate and safe use of these medications.
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Medical emergency teams are developing across the United States. The organization and implementation for a rapid response team to failing medical-surgical patients has been shown to reduce in-house cardiac arrest rates. Further investigation into the frequency and pattern for rapid response team calls has been shown to have a diurnal pattern and clustered around times associated with routine care activities. ⋯ The calls are found to be called with--frequency during the hours of 7 AM and 7 PM. The frequency of calls is shown to be clustered around the times of. The small descriptive analysis here suggests that further investigation in the patterns and monitoring of patient for early recognition to call for help is still needed.