American journal of critical care : an official publication, American Association of Critical-Care Nurses
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The reliability of intrabladder pressure measurements obtained in nonsupine patients is unknown. ⋯ Reliability of intrabladder pressure measurements obtained with 30 degrees head-of-bed elevation is strong.
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Comparative Study
Iced vs room-temperature injectates for cardiac index measurement during hypothermia and normothermia.
Few data are available on the accuracy of thermodilution measurements of cardiac index with room-temperature injectates and a closed delivery system in patients with low cardiac indexes and/or hypothermic body temperatures. ⋯ Although significant differences in thermodilution cardiac index were found between room-temperature and iced injectates during hypothermic body temperatures, these differences were small (mean, <0.11). These findings add to the results of the few studies on accuracy of room-temperature injectates for thermodilution measurement of cardiac index.
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Accurate assessment and management of pain in critically ill patients who are nonverbal or cognitively impaired is challenging. No widely accepted assessment tool is currently in place for assessing pain in these patients. ⋯ Implementation of the Nonverbal Pain Scale in a critical care setting improved patients' ratings of their pain experience, improved documentation by nurses, and increased nurses' confidence in assessing pain in nonverbal patients.
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Tailoring care for patients and their families at the end of life is important. ⋯ Blacks are 1.9 times as likely as others to choose full code at time of death. Cultural differences should be acknowledged when providing end-of-life care.
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Case Reports
Amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation.
Amniotic fluid embolism is a rare syndrome with potentially lethal outcomes. Complications include cardiorespiratory failure, disseminated intra-vascular coagulation, seizures, neurological deficits, and death. A 34-year-old woman had amniotic fluid embolism complicated by paradoxical embolism and disseminated intravascular coagulation. ⋯ Subsequent treatment with anticoagulants for 6 months was recommended. A literature review revealed that this clinical scenario is rare but can be successfully managed by cardiopulmonary bypass and thromboembolectomy. Data on guidelines for the use of anticoagulation in this situation are limited.