Critical care nursing clinics of North America
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Airway management skills are critical to patient care in many settings. Patients with a difficult airway present unique challenges and considerations, and clinicians should assess for this condition by obtaining a thorough history and physical examination. Familiarity with difficult airway management guidelines, algorithms, tools, and techniques is essential to formulating a safe and effective plan for intubation as well as extubation. This article focuses on airway evaluation, identification, planning, extubation, and care of the patient with a difficult airway.
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Patients who require general anesthesia to undergo a surgical procedure often require mechanical ventilation during the perioperative period. Ventilators incorporated into modern anesthesia machines offer various options for patient management. The unique effects of general anesthesia and surgery on pulmonary physiology must be considered when selecting an individualized plan for mechanical ventilation during the perioperative period. In this article, the pulmonary effects of general anesthesia are reviewed and available options for mechanical ventilation of the anesthetized patient during the perioperative period are presented.
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Crit Care Nurs Clin North Am · Mar 2015
ReviewMassive transfusion for hemorrhagic shock: what every critical care nurse needs to know.
Massive transfusion is defined as complete replacement of a patient's blood volume or approximately 10 units of packed red blood cells within a 24-hour period or one red blood cells volume in 24 hours for a pediatric patient. This article reviews the most recent understanding and recommendations in massive transfusion along with the unintended consequences in the management of patients with profound hemorrhage.
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Crit Care Nurs Clin North Am · Mar 2015
ReviewSedation options for intubated intensive care unit patients.
A common requirement for intubated patients in the intensive care unit (ICU) is sedation and pain management to facilitate patient safety and timely, atraumatic healing. The Society of Critical Care Medicine guidelines for management of pain, sedation, and delirium in adult ICU patients provide assessment scales for pain, sedation, and delirium; medications for sedation and pain management, and protocols for weaning sedation, are discussed. Proficient assessment skills, pharmacologic knowledge of medications administered to provide sedation, and an understanding of the importance of nonpharmacologic interventions can help the registered nurse provide patient advocacy, safety, and improved outcomes.
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Evidence-based medicine has been slow to address the critically important issue of intraoperative fluid maintenance for surgical patients. A "rule" published by Holliday and colleagues in 1957 was the accepted practice for the initial calculation of fluid maintenance for nearly 50 years. Using this formula, the nil per os fluid deficit was based on how long it had been since the preoperative patient had last consumed anything by mouth, even water. New technology and monitoring modalities are being used to guide evidence-supported intraoperative care, leading to better outcomes for surgical patients.