Articles: critical-care.
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The initial management of patients with multiple trauma requires a well-defined plan of action for immediate and adequate therapy, that ensures fast recognition of life-threatening conditions and injuries. While treatment protocols for specific situations and injuries are fairly well defined, there are few such concepts for the overall management process. Therefore, we designed a comprehensive algorithm for in-hospital trauma care to give priority-based guidelines to the trauma room physician. ⋯ The first algorithm starts with the initial assessment of immediate life-threatening disorders of A (airways), B (breathing) and C (circulation) and is followed by the early stabilization and maintenance of vital functions. It is followed by six interrelated flow charts, based on disturbed physiological functions (respiration, circulation) and anatomical injuries (thorax, abdomen, head/brain, spine/pelvic girdle/extremities), which are worked up simultaneously and repeatedly. This algorithm is not only intended as an overall guideline for use the management of severely injured patients, but is also indispensable for quality assurance.
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The incidence and nature of and the outcome following adverse events were studied prospectively in a surgical intensive care unit over a period of 1 year. From a total of 657 patients, 229 (34.8%) suffered 369 adverse events. The number of adverse events per patient ranged from 1 (58.1%) to a maximum of 4 (6.1%). ⋯ There was no significant difference in mortality between patients with single or multiple events. Twenty-two patients died as a direct result of the event, the commonest reason being loss of airway control. Adverse events contribute significantly to mortality in critically ill patients.
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This literature review was done to explore the use of master's-prepared nurse practitioners to manage critically ill patients. Data-based, anecdotal, clinical, analytic, and position papers published over the past 10 years in the medical and nursing literature were reviewed. This article synthesizes findings on the use of nurse practitioners in clinical settings including primary and specialty care settings, describes favorable outcomes of advanced practice nurses, and identifies factors that must be addressed as these roles increase in use in critical care settings. ⋯ Additional federal support to ensure the preparation of these practitioners in adequate numbers is needed. Attention to issues of direct reimbursement, salaries, impact of changing role boundaries, malpractice coverage, and prescription privileges must be addressed. Research programs to examine the effect of nurse practitioners in specialized care should continue.