Critical care nursing clinics of North America
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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.
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Crit Care Nurs Clin North Am · Dec 2014
ReviewTransitional care models: preventing readmissions for high-risk patient populations.
Transition from hospital to home is a vulnerable period for older adults with multiple chronic conditions. A pilot of the Transitional Care Model at a community hospital reduced readmission rates for patients with heart failure by 48%. This article shares the experience of a large metropolitan health care system in expanding transitional care across facilities to decrease readmission rates.
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Crit Care Nurs Clin North Am · Dec 2014
ReviewDriving sepsis mortality down: emergency department and critical care partnerships.
This article describes the Baylor Health Care System (BHCS) approach to decreasing sepsis-related mortality within a large complex adaptive health care system. BHCS implemented sepsis care improvement initiatives based on the Surviving Sepsis Campaign early goal directed therapy guidelines. By adhering to rigorous process improvement and evidence-based practice principles, BHCS has demonstrated improvements in sepsis care processes and a significant reduction in sepsis mortality.