Articles: critical-care.
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Recent studies showed that the patient work of breathing may be unexpectedly high during mechanical ventilation. During assisted mechanical ventilation and synchronous intermittent mechanical ventilation particularly, attention must be paid to the patient work if the respiratory muscles are to be rested. Clinicians should observe chest wall movements to recognize inspiratory efforts and incoordination. Monitoring the profile of inspiratory airway pressure over time is also helpful, with irregular and only partially positive pressures indicating inspiratory effort by patients.
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I have reviewed the identifiable hemodynamic effects of selected inotropic and vasoactive agents in the context of several clinical patient subsets. Knowledge of relative hemodynamic effects of various agents permits the selection of those that are best in specific clinical circumstances. Combining drugs may only occasionally be advisable to supplement a desired effect or to attenuate an unwanted one.
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Crit Care Nurs Clin North Am · Sep 1991
ReviewInitial assessment and stabilization of the critically injured child.
The care that the child receives during the initial resuscitation and stabilization of a life-threatening injury makes a critical difference in long-term outcome. Children who die as a result of a traumatic injury usually do so because of airway compromise, irreparable CNS injury, or bleeding. Hypoxia is the final common event by which these three kill children. ⋯ The potential for a good outcome is maximized by expert nursing care for the critically injured child. Expert nursing care includes rapid and accurate assessment and interventions during both the primary and secondary surveys. Knowledge of the anatomic and physiologic differences between children and adults guides the nurse in holistic care of pediatric trauma victims; the nurse must also understand and address the emotional needs of the patients and their families.