American journal of critical care : an official publication, American Association of Critical-Care Nurses
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A survey of nurses' beliefs about the medical emergency team system in a canadian tertiary hospital.
Nurses are the primary activators of the medical emergency team (MET). Although the MET system can empower nurses to seek help in managing acutely ill patients, few data on nurses' beliefs about the system are available. ⋯ Nurses value the MET system. Nurses believe that the MET can help them care for acutely ill patients and improve outcomes. However, barriers to MET activation exist, including a fear of criticism and an adherence to a more traditional model of first contacting the responsible physician before activating the MET.
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Reliance on physiological monitors to continuously "watch" patients and to alert the nurse when a serious rhythm problem occurs is standard practice on monitored units. Alarms are intended to alert clinicians to deviations from a predetermined "normal" status. However, alarm fatigue may occur when the sheer number of monitor alarms overwhelms clinicians, possibly leading to alarms being disabled, silenced, or ignored. ⋯ Although alarms are important and sometimes life-saving, they can compromise patients' safety if ignored. This unit-based quality improvement initiative was beneficial as a starting point for revamping alarm management throughout the institution.
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Multicenter Study Comparative Study
Racial differences in women's prodromal and acute symptoms of myocardial infarction.
Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority women's symptoms of coronary heart disease may contribute to these disparities. ⋯ Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of women's prodromal and acute symptoms should assist providers in interpreting women's symptoms.
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Comparative Study
A comparison of methohexital versus etomidate for endotracheal intubation of critically ill patients.
Methohexital has been used for procedural sedation in the emergency department, but its use for endotracheal intubation in intensive care units has not been studied. ⋯ Rates of successful intubation are similar with etomidate and methohexital. Methohexital provides adequate sedation and could be an alternative to etomidate, although both agents were often associated with development of hypotension. Prospective studies are needed to establish the safety of methohexital use in intensive care patients.
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Patients receiving mechanical ventilation are at high risk for pneumonia due to aspiration. Published guidelines recommend elevating the head of the bed 30 degrees to 45 degrees , if not contraindicated, to reduce risk, but this intervention is underused. ⋯ A nursing clinical decision support system integrated into a patient's electronic flow sheet can increase nurses' adherence to guidelines. Pulmonary and gastrointestinal diagnoses, body mass index, and tube feeding are predictors of elevation of the head of the bed.