Dynamics (Pembroke, Ont.)
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Dynamics (Pembroke, Ont.) · Jan 2003
ReviewReview of laryngospasm and noncardiogenic pulmonary edema.
Laryngospasm is an emergency situation that requires rapid identification and resolution of the obstructed glottis. Although there is a low incidence of laryngospasm, it is important to remember that any patient has the potential for post-extubation laryngospasm. Nurses must know about the causes, risk factors and treatment for this respiratory emergency. ⋯ The triggers, signs and symptoms, and treatment of NCPE are also reviewed. Due to the risk of laryngospasm recurring or NCPE presenting itself, any patient who has had laryngospasm needs close monitoring for two to three hours after the laryngospasm has resolved. It is important for nurses to review the interventions for laryngospasm and NCPE prior to caring for a patient with this respiratory emergency.
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Dynamics (Pembroke, Ont.) · Jan 2003
ReviewIntra-abdominal pressure monitoring for critically ill patients.
Increased intra-abdominal pressure (IAP) is associated with a variety of clinical situations and has profound effects, both locally and systemically, that may result in organ dysfunction and failure. If not identified and treated promptly, increased IAP can be fatal. Urinary bladder pressure monitoring is a simple and reliable method of quantifying IAP and is a key factor leading to prompt management and a successful outcome for patients.
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Dynamics (Pembroke, Ont.) · Jan 2003
Optimizing sedation and analgesia in mechanically ventilated patients--an evidence-based approach.
Critically ill, mechanically ventilated patients experience pain and anxiety related to a number of factors, including underlying disease processes, invasive procedures, therapeutic devices, immobility, and even routine nursing care such as turning and positioning. Failure to provide adequate analgesia and sedation has been shown to have detrimental physiological consequences, including an increase in sympathetic nervous activity and ventilator dyssynchrony (Young, Knudsen, Hilton & Reves, 2000). Over-sedation has also given rise to concerns related to prolongation of mechanical ventilation, intensive care unit (ICU) length of stay, and cost. ⋯ New strategies show promise and focus on a team approach for the management of sedation and analgesia in critically ill, mechanically ventilated patients. These strategies include the use of sedation protocols, which incorporate nurse-driven dose titration directives, sedation scoring systems, and daily interruption of sedative infusions. This article provides a review of three recent studies evaluating these new approaches to the administration of sedation and analgesia in the adult ICU.
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With a high percentage of ICU patients suffering from ARDS from a direct or indirect lung injury, successful therapy and treatment modalities are important for all of us to know. It is our hope, as critical care professionals, to assist the patient through the course of this complication and prevent further lung injury related to the increasing oxygen demands, high positive pressure ventilation, and high volumes. When traditional methods of improving ventilation fail, we do have the options of proning our patients and/or trying high frequency oscillating ventilation to optimize oxygen exchange. ⋯ Proning, high frequency ventilation, and the use of steroids played a role in the recovery of Mr. M. Aggressive nursing care helped minimize the complications from these treatments and aided in the psychosocial aspects of a challenging family dynamic.