Critical care nursing clinics of North America
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Crit Care Nurs Clin North Am · Sep 1989
Using hemodynamic waveforms to assess cardiopulmonary pathologies.
The pulmonary artery catheter brought measurement of hemodynamic parameters to the bedside in the early 1970s. The critical care clinician has been able to obtain direct and derived parameters that have proved useful in the diagnosis, management, and evaluation in various clinical conditions. The evaluation of the mechanical events in the heart, as evidenced through accurate interpretation of waveform configuration, has enhanced the diagnostic ability of the clinician. A wide variety of cardiopulmonary conditions can be recognized, including valvular defects, shunts, electrical disturbances and others, which allow the clinician to optimize hemodynamic function and impact patient survival.
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Triggering and timing of the intra-aortic balloon pump are becoming more sophisticated but more clinically manageable. The key to understanding the data currently available is to go beyond early instruction to "eyeball" waveform analysis. Conclusive assessment of the patient's response to therapy lies in a greater understanding of today's technology and clinical competency in evaluating the patient's total hemodynamic, clinical, and laboratory response to assure maximal therapeutic efficiency of counterpulsation therapy. ⋯ Since that time, we have gained a depth of knowledge and an increased capacity for measuring physiologic and hemodynamic responses at the bedside. Concurrently, the medical industry has designed faster, smarter, and more efficient equipment to complement patient care. The critical care nurse faces the challenge of synthesizing the newest information from both areas and developing a greater understanding of the ongoing care of the patient on the IABP.
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Crit Care Nurs Clin North Am · Jun 1989
ReviewHemodynamic monitoring modalities in pediatric cardiac surgical patients.
Transthoracic monitoring lines yield vital information in the care of the pediatric postoperative cardiovascular surgical patient. It is the critical care nurse, in the holistic care of the patient, who integrates this data into the daily plan of care. ⋯ The care of these critically ill infants requires a multifactoral approach. Hemodynamic monitoring is one of many avenues that we follow in the intensive care unit.
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Crit Care Nurs Clin North Am · Jun 1989
ReviewTranscutaneous cardiac pacing: expanding clinical applications.
Transcutaneous cardiac pacing is an exciting alternative to invasive endocardial pacing methods for the treatment of hemodynamically significant bradyarrhythmias. Prompt institution of a pacing support system is crucial for improving outcomes in this patient population. Recent advances in technology and microcircuitry have eliminated the problems of painful, musculoskeletal stimulation and excessive distortion of the ECG signal associated with earlier devices. ⋯ Prophylactic use of transcutaneous pacemakers in a variety of clinical situations, such as atrioventricular blocks, may eliminate the need for transvenous electrode insertion and its related complications. A transcutaneous pacing system with the capability of functioning in the demand mode should be readily available in emergency rooms, intensive care units, and telemetry floors. Although unlikely to replace transvenous methods, the growing popularity of this technique has many implications for the nurse in the critical care setting.
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The severity of injury in a gunshot wound is dependent on many factors, including the type of firearm; the velocity, mass, and construction of the bullet; and the structural properties of the tissues that are wounded. Knowledge of ballistics and an appreciation of the wounding potential of certain firearms and their ammunition can help clinicians anticipate the severity of a wound and raise the index of suspicion for occult but severe internal trauma.