AACN clinical issues
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AACN clinical issues · Feb 1999
ReviewTemperature management in trauma patients across the continuum of care: the TEMP Group. Temperature Evaluation and Management Project.
Hypothermia is a potentially preventable consequence of injury in the trauma patient. The physiologic aftermath of hypothermia is such that it is regarded as one of the three components in the trauma triad of death. A multidisciplinary group at a Level I trauma center was formed to originate an innovative team approach to managing temperature in trauma patients. This article describes this unique project to combat a preventable cause of significant morbidity and mortality.
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AACN clinical issues · Feb 1999
ReviewThe trauma triad of death: hypothermia, acidosis, and coagulopathy.
With the organization of trauma systems, the development of trauma centers, the application of standardized methods of resuscitation, and improvements in modern blood banking techniques, the ability to aggressively resuscitate patients in extremis has evolved. The concept of the "golden hour" has translated into unprecedented speed and efficiency of trauma resuscitation with the ultimate goal of short injury-to-incision times. ⋯ Critical care nurses must understand this triad, because it forms the basis and underlying logic on which the damage control philosophy has been built. This article explores the pathogenesis and treatment of acidosis, hypothermia, and coagulopathy as it applies to the exsanguinating trauma patient.
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The critically injured trauma patient in severe hemorrhagic shock presents a complex and arduous challenge to even the most experienced trauma staff. Lives are at stake as trauma teams feverishly pour massive amounts of blood into severely injured patients attempting to replace entire blood volumes several times over. ⋯ Other treatments, such as autotransfusion and blood substitutes, are promising adjunctive therapies that may in the near future help to improve outcomes in patients who require massive blood transfusions. This article reviews the current standard of care for the trauma patient requiring massive transfusion.
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Swallowing and respiration are well-coordinated and interdependent functions. When one of these processes is impaired, the ramifications may be negative for the other. This article describes the mechanics of normal swallowing, the disorders of swallowing, the effects of tracheotomy and mechanical ventilation on swallowing, and the procedures used to assess and treat swallowing. Combining a basic understanding of these concepts with practical management can increase safe and efficient oral intake in patients with artificial airways.
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Acute care nurse practitioners (ACNPs) entering the current job market or relocating must be able to sell their personal and professional attributes to potential employers. In many areas, health care providers may be unfamiliar with the scope of practice and competencies of an ACNP. As a result, ACNPs will be required to educate potential employers as they simultaneously negotiate for a position. ⋯ An attitude that projects an unwavering belief in the value and benefits of the ACNP can enhance the negotiator's position and improve the chances for success. Creating the proposal and developing attitudes for success can be accomplished through an organized process of preparing for negotiations. The purpose of this article is to describe the attitude needed for success, the steps in preparing for negotiation, and the development of an ACNP proposal.