Aust Crit Care
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Secondary brain injury is associated with a reduction in cerebral blood flow, oxygenation and perfusion related to hypotension, hypoxemia and raised intracranial pressure. This has been confirmed on autopsy and is associated with a higher mortality rate, as supported by many studies. The primary goal of nursing management in severe head trauma is to maintain adequate cerebral perfusion and improve cerebral blood flow in order to prevent cerebral ischaemia and secondary injury to the brain. ⋯ The majority of the evidence was derived from class II and class III classifications, which provide guidelines and options for practice. Nursing and medical management were found to overlap, with the focus for the nurse being an integrated balance of scientific, technical and humanistic management. The nurse's role is extremely important because the expert nurse cognitively manipulates many variables over a continuum of care and, if such tasks are skillfully and successfully performed, the incidence of secondary brain injury is reduced.
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The medical emergency team (MET) at Liverpool Hospital superseded the cardiac arrest team in 1990 and can be summoned by any staff member who identifies a patient at risk according to preset criteria; for example, severe hypotension. Weekly reviews of MET calls have identified clinical antecedents present prior to the patient's condition deteriorating to a critical level. This study assessed the responses of nurses in the presence of these warning signs. ⋯ The predominant response to a clinical antecedent was to call the MET (68.4 per cent). Other responses resulted in delays of 1 hour (18 per cent) and up to 3 hours (8 per cent) on some wards before treatment specific to the clinical antecedent commenced. A need to educate health professionals regarding the warning signs of acute severe illness and when to summon assistance has been identified.
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Technological advances in health care have made it possible to restore and prolong life for patients who would have died in the past. Unfortunately, one consequence of this is that some patients linger in intensive care units (ICUs), dependent on the technologies but with no hope of recovery. Therefore, decisions regarding withdrawal of life-support treatment are increasingly being faced by the health-care team. ⋯ The study highlighted the importance of honest communication during the processes of decision-making and withdrawal of treatment. It was important for these nurses to be sure that family members were well-informed regarding the process of withdrawal of life-support treatment and that they could provide support and ensure that the patient's comfort and dignity were maintained during the process. The need to debrief after the event became evident but formal debriefing processes were rarely undertaken.