Articles: critical-care.
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To develop an objective method for assessing organ dysfunction among intensive care unit (ICU) patients on the first day of the ICU stay. ⋯ The LOD System provides an objective tool for assessing severity levels for organ dysfunction in the ICU, a critical component in the conduct of clinical trials. Neurologic, cardiovascular, and renal dysfunction were the most severe organ dysfunctions, followed by pulmonary and hematologic dysfunction, with hepatic dysfunction the least severe. The LOD System takes into account both the relative severity among organ systems and the degree of severity within an organ system.
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During a period of one year, 126 patients were prospectively audited to analyse complications of endotracheal intubation in a general intensive care unit setting. A total of 62 complications were observed in 48 patients. ⋯ Sore throat was the commonest (22%) complication following extubation. Other complications like stridor and ulceration of mouth and lips which followed extubation were not related to the duration of intubation.
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Snake bite envenomation demands a high level of knowledge and skill on the part of the critical care nurse. The following paper examines a case study of one patient who presented on two separate occasions, with snake bites from a taipan and then, 6 months later, from a death adder. ⋯ This paper seeks to examine the different management required for each specific episode of envenomation. It compares the characteristics of the two snakes and examines the different effects of envenomation in both cases.
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Delirium, a syndrome that results in high morbidity and mortality rates in the elderly, continues to be underrecognized by physicians and nurses. Factors influencing the underrecognition of delirium are specific to individual institutions and their health care providers. ⋯ As a result of this study, staff education, assessment protocols, and improved communication and documentation techniques are indicated as targeted methods for improving recognition and treatment of delirium in this setting. Similar case studies can be performed to evaluate institutional practice, and thereby identify barriers to early recognition of delirium.
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Randomized Controlled Trial Clinical Trial
Evaluation of a hospital-based youth violence intervention.
To decrease adolescent morbidity and mortality and improve the quality of life, a violence-prevention consultation is offered to hospitalized victims of nondomestic violence. The context is a violence-prevention team approach to patient assessment, treatment, and follow-up. Psychoeducational counseling emphasizes the individual through a cognitive behavioral approach and also recognizes the individual in the proximal social setting through referrals to community resources. ⋯ No statistically significant differences between intervention subjects and nonintervention controls in terms of baseline variables have been observed. For inner-city adolescent victims of violent assaults, a hospital-based intervention offers a unique opportunity for reduction of the incidence of reinjury. We describe the elements of the intervention, including the theoretical basis and implementation; detail the overall evaluation design including modifications; and present preliminary analyses of baseline data.