Aust Crit Care
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Patients presenting at emergency departments with isolated limb trauma face chronic delays due to over crowding and over utilisation of these departments for primary health care. Excessive waiting periods for assessment, definitive diagnostic procedures and subsequent treatment plans compound the current access block for emergency care, with these factors contributing to patient dissatisfaction. ⋯ To ensure x-rays are accurately and appropriately ordered, it is suggested that strict guidelines and structured educational programmes for nurses be implemented. The findings from this literature review suggest that extending the triage role to include nurse initiated x-rays has the potential to decrease waiting times and to increase patient satisfaction in the emergency department.
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Patients in acute respiratory failure (ARF) frequently present to the emergency department (ED). Traditionally management has involved mechanical ventilation via endotracheal intubation. Such invasive forms of treatment, however, correlate with a higher incidence of infection, mortality, length of stay and contribute to the costs of intensive care. ⋯ Particular attention will focus on the comparative theoretical advantages of BiPAP in relation to continuous positive airway pressure (CPAP), and a review of recent research. Discussion will incorporate timeliness in the application of BiPAP, indicators of successful treatment, appropriate manipulation of pressure settings, nursing workload and management of patients beyond the ED. Whilst the theoretical advantages of BiPAP ventilation are acknowledged, larger randomised controlled research studies are recommended in order to clearly ensure its safe and effective application in the treatment of ACPO.
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The carbonic acid/bicarbonate system, as defined by the Henderson-Hasselbach (H-H) equation, has traditionally formed the centrepiece of the presentation of acid/base physiology in nursing education. However, an alternative approach to describe acid/base physiology was proposed by Peter Stewart in 1983. Stewart determined, using the physiochemical principles of dissociation equilibrium, electroneutrality and conservation of mass, that hydrogen ion concentration [H+] was dependent upon the difference between the concentrations of strong cations and strong anions in a solution (the strong ion difference or SID), concentration of weak acid anions, and the partial pressure of carbon dioxide in plasma. ⋯ An analysis of the complex acid/base derangements commonly seen in the critically ill can be achieved using this approach. The acid/base consequences of vomiting, gastric aspiration, diarrhoea, diuretic therapy, the infusion of large volumes of normal saline, the contribution of lactate, and the effects of methanol and ethylene glycol poisoning can all be more readily understood considering Stewart's explanation of acid/base balance. This paper outlines this alternative approach and provides some examples for the intensive care setting.
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Advances in medical practice and technology and the success of organ transplantation over the past 2 decades have resulted in an increased demand for organ donors. However, the health care community and organ procurement organisations (OPO) are faced with a worldwide shortage of donor organs. The non-consent of families is the most common reason that organs of medically suitable potential donors are not recovered. ⋯ The literature review indicates that the significant factors associated with denial of consent include: the misunderstanding of brain death; cultural beliefs; the specific timing of the request; the setting in which the request is made; the approach of the individual making the request; and characteristics of the deceased. Organ donation and transplantation rates could be increased by the joint involvement of medical, nursing and OPO personnel to enhance the quality of hospital care and to ensure that requests for donation are handled in a way that meets the family's informational and emotional needs. Increased consent rates have the potential to save lives and improve the quality of life for organ recipients.