Nursing in critical care
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--Mortality of patients with severe sepsis remains at unacceptable levels and recent new strategies are not being widely embraced. --Five strategies are discussed within this article [low tidal volumes in acute lung injury/acute respiratory distress syndrome, early goal-directed therapy, drotrecogin alfa (activated), moderate dose corticosteroids and tight control of blood glucose]. --The critical care nurse plays a leading role in the detection, monitoring and treatment of patients with severe sepsis. --The role of the critical care nurse within the multidisciplinary team is explored. --Education, combination of strategies and the use of protocols are discussed.
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Nursing in critical care · Nov 2004
ReviewA review of the efficacy and safety of opioid analgesics post-craniotomy.
--Codeine phosphate is the most commonly used analgesic post-craniotomy. --It is argued, in this paper, that codeine phosphate is an unpredictable pro-drug that does not equate to a safe and effective method of providing analgesia post-craniotomy. --Lack of evidence supporting tramadol's usage and concerns over its interactions and side effects mean its use cannot be advocated. --The traditional justification for withholding morphine in post-craniotomy pain appears to be largely based on anecdotal evidence. --Raising awareness among critical care nurses of the pharmacological properties of the analgesics used is imperative, if post-craniotomy pain is to be adequately treated. --There is an explicit challenge to the neurosurgical community to re-evaluate their pain-management strategies in the post-craniotomy patient.
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Nursing in critical care · Sep 2004
Practice Guideline GuidelineBritish Association of Critical Care Nurses position statement on the use of restraint in adult critical care units.
Critical care nurses in the United Kingdom have become increasingly concerned about the use, potential abuse and risks associated with physical restraint of patients. Restraint in critical care is not only confined to physical restraint but can also encompass chemical and psychological methods. There are concerns regarding the legal and ethical issues relating to the (ab)use of physical restraint techniques in critical care. The aim of this article was to present the British Association of Critical Care Nurses (BACCN) position statement on the use of restraint in adult critical care units and to provide supporting evidence to assist clinical staff in managing this process.
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Nursing in critical care · Sep 2004
A study exploring factors which influence the decision to commence nurse-led weaning.
Nurse-led weaning can improve patient outcome. Exploration of the factors that influence the commencement of weaning. ⋯ Experience was a key factor in the decision to wean. The use of protocol-led weaning may not be useful in the decision to wean.