AACN clinical issues
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Coagulopathy after traumatic injury has multiple etiologies. It may result from overwhelming activation of tissue factor, consumption of circulating coagulation proteins, massive transfusion, metabolic alterations, hypothermia, or any combination of these factors. ⋯ Development of a coagulopathy has a significant impact on the morbidity and mortality of the patient with trauma. This article describes the relevant pathophysiology as it relates to the development of a coagulopathy, prevention strategies, and management principles applied in caring for the patient with trauma and a coagulopathy.
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AACN clinical issues · May 2002
ReviewSickle cell anemia in the pediatric intensive care unit: novel approaches for managing life-threatening complications.
Although the manifestations of sickle cell disease (SCD) do not typically necessitate critical care management, several life-threatening complications may require admission to the pediatric intensive care unit. Children with SCD are at risk for serious complications such as vaso-occlusive pain crises, cerebral vascular accidents, acute chest syndrome, severe anemia related to aplastic and splenic sequestration crises, infection, and multiorgan failure. Despite years of study, little progress has been made in understanding the pathophysiology of SCD. ⋯ Perhaps most exciting are the advances in bone marrow and stem cell transplantation, which offer hope of an eventual cure for this debilitating and deadly disease. Advanced practice nurses play a pivotal role in coordinating care for these critically ill children. Knowledge of both current and investigational therapies allows the advanced practice nurse to provide comprehensive, state-of-the-art care to children with life-threatening complications of SCD.