Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Jun 1993
Optimizing resuscitation outcomes with pharmacologic therapy.
Pharmacologic therapy plays a key role in the emergency resuscitation of patients with cardiac arrest. The Advanced Cardiac Life Support guidelines sanctioned by the American Heart Association provide flexible treatment protocols (algorithms) that serve as a valuable tool for clinicians. ⋯ Despite continued investigation and recent advances in our understanding of the role of drugs and other therapeutic interventions, the short-term and long-term prognoses of patients with cardiac arrest, especially out-of-hospital arrest, remain dismal. Clearly, much study into the prevention and treatment of sudden cardiac death is desperately needed.
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Crit Care Nurs Clin North Am · Jun 1993
Pharmacologic treatment of acute congestive heart failure resulting from left ventricular systolic or diastolic dysfunction.
Patients presenting in acute congestive heart failure demonstrate severe dyspnea, rales, hypoxia, and chest radiograph findings of acute pulmonary vascular congestion. Not all patients, however, have systolic left ventricular dysfunction. While initial stabilization of an acute episode in decompensated heart failure may follow a common pathway, understanding the nature of the dysfunction is important in selecting both short-term and long-term pharmacologic interventions required in the patient's management.
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Crit Care Nurs Clin North Am · Jun 1993
Provision of pharmaceutical care in the intensive care unit.
The highly specialized knowledge and skills necessary to care for critically ill patients requires a team approach involving physicians, nurses, pharmacists, and other health care providers. The role of the pharmacist in the intensive care unit is evolving rapidly to a new responsibility for ensuring definite drug therapy outcomes that improve the patient's quality of life. The provision of pharmaceutical care by pharmacists involves identifying, resolving, and preventing drug-related problems. Many medication errors, adverse drug reactions, drug interactions, and inappropriate therapies can be avoided, which will certainly benefit the patient as well as the nursing professions.
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Neuromuscular blocking agents have been used in critically ill patients for over 30 years. Recently, the pharmacology, monitoring, and toxicity of these agents have received much attention. This article reviews the pharmacology, indications, monitoring parameters, and toxicity of the neuromuscular blocking agents commonly used in the intensive care unit.
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Advances in our understanding of the immune system and the body's normal response to injury have allowed for the development of innovative new therapies for critically ill patients. In the area of sepsis, significant information is being generated to support the concept that adjunctive immunotherapy can improve both morbidity and mortality. Investigational agents directed at immunotherapy targets that are currently being studied include colony stimulating factors, immunoglobulins, anticytokines, and opioid antagonists. This article reviews the basis for the use of such adjunctive immunotherapy in the critically ill patient.