Articles: critical-care.
-
The neurological assessment of patients admitted to the intensive care unit after successful resuscitation from cardiopulmonary arrest may be difficult. We describe the cases of two patients who developed myoclonus within 24 hours of hypoxic respiratory and cardiac arrest. Initially, the clonic movements were thought to be generalised convulsions and were treated as such, until it became evident that the patients were aware and distressed. ⋯ Recognition depends on the awareness that the syndrome exists, and is important so that correct therapy can be instituted. There may be important prognostic implications. Both our patients had normal intellectual recovery with moderate residual neurological disability from their movement disorder.
-
Family needs research has for the most part focused on the families' perceptions when a significant other is admitted to the intensive care unit. We examined critical care nurse perceptions of family needs. The questionnaire "Needs of Families of Critically Ill Patients" was given to 126 intensive care unit nurses. ⋯ Cognitive family were ranked higher than psychologic or personal and physical needs. Nurses from the four intensive care units ranked family needs significantly differently, a result that may be influenced by differing patient acuity and patient length of stay on individual units. Nurses' perceptions of family needs were influenced by units worked, length of time practicing in critical care, educational preparation, and length of time in nursing.
-
Intensive care is being scrutinized as a major factor in increasing health care costs. We examined 404 consecutive admissions to the medical ICUs at a university medical center to study patterns of consumption of ICU resources and the proportion of resources used by patients admitted for monitoring only. ⋯ Reducing the number of patients admitted for monitoring will have a relatively small impact on hospital charges. Since over 70 percent of the high-cost patients died, improved understanding of prognosis and better physician-patient communication may substantially reduce the proportion of critical care resources expended on futile treatment.
-
We continually monitored components of the Fick equation (oxygen consumption, arterial and mixed venous oxygen saturation) simultaneously in ten hemodynamically stable, mechanically ventilated postoperative patients in order to evaluate our ability to continually calculate cardiac output (Qc) from its Fick determinants. Qc underestimated (p less than 0.001) cardiac output calculated from intermittent CO-oximeter measurements (6.2 vs 6.4 L/min) with good correlation (r = .96), while it consistently overestimated (p less than 0.05) thermodilution cardiac output (Qtd) (6.2 vs 5.9 L/min, r = .84). ⋯ We conclude that continual trending of Fick variables in critically ill patients is both feasible and useful and that Qc agrees well with both traditional Fick cardiac output computed from CO-oximetry data and thermodilution measurements. Finally, measured oxygen consumption, available continuously, correlates well with changes in cardiac output in this subset of critically-ill patients.
-
Many legal implications related to standards of care exist for the critical care nurse. This article tells how care standards are derived and used in the legal system, describes important legal concepts, and gives samples of actual court testimony by nurses about endotracheal tube cuff care.