Articles: patients.
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Intensive care medicine · Dec 1999
Comparative StudyStressors in ICU: perception of the patient, relatives and health care team.
To compare the evaluation of the stressors present in the intensive care unit (ICU) from the point of view of the patient, relatives and the multiprofessional team and to identify differences and similarities with regard to the perception of stressors in order to optimize patient care. ⋯ Being in pain, being unable to sleep and having tubes in the nose and/or mouth were pointed out as the major stressors by the three groups. There was no statistically significant correlation between the total stress scores of the patients and their relatives (r = 0.193), between the patients and the team (r = -0.002), or between the total scores of the team and the relatives (r = -0.185). The results suggest that the views of the relatives and the professional team concerning the stressors have some similar points compared to the evaluation made by the patient himself, although the intensity of the evaluation for each group corresponds to its own perception.
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Transesophageal echocardiography (TEE) is an invaluable diagnostic tool, particularly in patients with inadequate transthoracic echocardiographic examinations. In addition, continuous TEE has been used to monitor ventricular and valvular performance in the intensive care unit and the operating room. However, current generation transesophageal probes have limitations in the critical care setting due to their size. ⋯ Nasal intubation with the probe was more likely in intensive care patients, ventilated subjects, and patients who were intubated for > 1 hour. TEE with this miniaturized probe is feasible and safe even in multi-instrumented critical care patients. This probe provides adequate diagnostic imaging capabilities and may allow imaging over prolonged periods of time, making it suitable for the serial monitoring of ventricular performance.
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Complex regional pain syndrome-reflex sympathetic dystrophy (CRPS/RSD) is a complex pain-dysfunction syndrome of unknown cause that typically affects a single extremity. Changes are usually more marked peripherally. There are no generally accepted clinical diagnostic criteria or laboratory studies for CRPS/RSD; our current state of knowledge allows the diagnosis to be made only on clinical grounds. ⋯ Treatment should be immediate, aggressive, and directed toward restoration of full function of the extremity. Various analgesic techniques may be necessary to permit the patient to comply with the rehabilitation program. This program is best carried out in a comprehensive interdisciplinary setting, with a primary emphasis on functional restoration.
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To discuss ethical and legal aspects of physicianś attitudes in emergency departments under the light of Braziĺs codes and laws. ⋯ The commentaries presented in the article try to explain to the pediatrician how to identify ethical and legal conflicts in the emergency department and to prepare him (her) to assume attitudes based on codes and legal statements, as well as to respect the patient's rights.
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More than 1,000 patients experience sudden cardiac arrest each day. Treatment for this includes cardiopulmonary resuscitation (CPR_ and emergency medical services (EMS) that provide CPR-basic life support (BLS), BLS with defibrillation (BLS-D), or advanced life support (ALS). Our previous systematic review of treatments for sudden cardiac arrest was limited by suboptimal data. Since then, debate has increased about whether bystander CPR is effective or whether attention should focus instead on rapid defibrillation. Therefore a cumulative meta-analysis was conducted to determine the relative effectiveness of differences in the defibrillation response time interval, proportion of bystander CPR, and type of EMS system on survival after out-of-hospital cardiac arrest. ⋯ Thirty-seven eligible articles described 39 EMS systems and included 33, 124 patients. Median survival for all rhythm groups to hospital discharge was 6.4% (interquartile range, 3.7 to 10.3). Odds of survival were 1.06 (95% confidence interval [Cl], 1.03 to 1.09; P<.01) per 5% increase in bystander CPR. Survival was constant if the defibrillation response time interval was less than 6 minutes, decreased as the interval increased from 6 to 11 minutes, and leveled of after 11 minutes (P<.01). Compared with BLS-D, odds of survival were as follows: ALS, 1.71 (95% Cl, 1.09 to 2.70; P=.01); BLS plus ALS, 1.47 (95% Cl, 0.89 to 2.42; P=.07); and BLS with defibrillation plus ALS, 2.31 (95% Cl, 1.47 to 3.62; P<.01.) Conclusion: We confirm that greater survival after sudden cardiac arrest is associated with provision of bystander CPR, early defibrillation, or ALS. More research is required to evaluate the relative benefit of early defibrillation versus early ALS.