Articles: critical-care.
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The results of a national survey of critical-care pharmaceutical services are reported. A questionnaire was mailed on March 8, 1988, to 1500 of the 6800 U. S. hospitals with more than 100 beds. ⋯ There were no differences between satellite and nonsatellite ICU pharmacists in either the percentage of a typical day spent providing clinical services to critical-care patients or the percentage of critical-care patients receiving those services. Respondents expected their hospitals to add 301 full-time-equivalent critical-care pharmacists to their staffs during the next two years, for a 39% increase. Respondents strongly favored establishing 24-hour unit dose drug distribution and i.v. admixture services, providing inservice education to nurses and physicians, and providing written pharmacokinetic consultations.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review
Practical aspects of epidural and intrathecal narcotic analgesia in the intensive care setting.
The administration of epidural and intrathecal narcotics is a technique of providing postoperative analgesia that is gaining popularity in many operating rooms, labor suites, and intensive care units. The epidural and intrathecal methods, first introduced a century ago, have been implemented as additional techniques for the administration of narcotic analgesics. Patients who have received epidural or intrathecal narcotics are frequently admitted to the intensive care unit for postoperative care. Because of their continuous proximity to the patient and their monitoring skills, critical care nurses are able to evaluate the analgesic effect and intervene in the event of a complication.
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Critical care medicine · Nov 1989
Use of survivors' cardiorespiratory values as therapeutic goals in septic shock.
The responses to therapy of 29 patients in septic shock are described. Patients received controlled plasma volume expansion followed by infusions of norepinephrine, dobutamine, and dopamine to achieve appropriate therapeutic goals. ⋯ The overall hospital survival rate was 52%. We suggest that the rational use of adrenergic agents and the achievement of appropriate physiologic end-points for therapy not only result in the reversal of hypotension, but also maintain or increase Do2 and Vo2, and may improve survival.