Rapid Ultrasound for Shock and Hypotension: A Clinical Update for the Advanced Practice Provider: Part 1.

The Rapid Ultrasound for Shock and Hypotension (RUSH) examination is used for patients with hypotension without clear cause or undifferentiated hypotension. In the emergency department setting, clinicians may perform the RUSH examination to supplement the physical assessment and differentiate the diagnosis of hypovolemic, obstructive, cardiogenic, and distributive forms of shock. The key elements of the RUSH examination are the pump, tank, and pipes, meaning potentially causes of the hypotension are examined within the heart, vascular volume and integrity, and the vessels themselves. Clinicians follow a systemic protocol to seeking evidence of specific conditions including heart failure exacerbation, cardiac tamponade, pleural effusion, pneumothorax, abdominal aortic aneurysm, and deep vein thrombosis. Because ultrasonography is a user-dependent skill, the advanced practice nurse in the emergency department should be educated regarding the RUSH protocol and prepared to implement the examination.

Mixed Shock States: A Case for the Pulmonary Artery Catheter.

The pulmonary artery catheter is a valuable tool available to the clinician for use in deciphering complex hemodynamic scenarios. Patients in shock, particularly those who are elderly or have premorbid conditions such as heart failure, may have atypical presentations. Additional hemodynamic data may help identify interventions that might seem counterintuitive, such as the use of vasoconstrictors in patients with low cardiac output. Interpretation of pulmonary artery hemodynamic data is a skill that should not be relegated to the past. This article reviews the use of a pulmonary artery catheter in mixed shock states. A case study is used to demonstrate how pulmonary artery catheter hemodynamic values can guide the care of these patients.

Caring for patients with a traumatic spinal cord injury.

ABSTRACT: The physical, emotional, and financial impact of a traumatic spinal cord injury (TSCI) can be devastating. This article discusses the pathophysiology of TSCI, medical and surgical management during the acute and subacute phases of injury, and nursing care for patients with TSCI.

Nurses' cognitive and perceptual bias in the identification of clinical deterioration cues.

BACKGROUND: Perception and processing of clinical cues have rarely been investigated in the nursing literature despite their relevance to the early identification and management of clinical deterioration. AIM: This study used a hypovolemic shock scenario from the Feedback Incorporating Review and Simulation Techniques to Act on Clinical Trends (FIRST2ACT) virtual simulation program, equipped with an eye tracker, to investigate cue processing during the management of patient deterioration. RESULT: The study revealed that attention deviation distorted interpretation of subsequent cues, causing 63% of participants to exhibit a cognitive bias (heightened sensitivity to specific but noncritical cues) and 65% to exhibit at least one episode of nonfixation on clinically relevant cues. Attention deviation and distorted interpretations of clinical cues will have an impact on patient safety. CONCLUSION: The findings are likely to have important implications for understanding error and associated training implications.

Causal analysis of the impact of homecare services on patient discharge disposition.

This study uses observational causal inference to evaluate the impact of different combinations of home care services (nursing, therapies, social work, home aides) on end-of-episode disposition for individuals with chronic diseases associated with the circulatory, endocrine, and musculoskeletal systems. The potential to generate actionable recommendations for personalizing home care services, or treatment plans, from limited clinical and care needs data is demonstrated. For patients with chronic disease in the circulatory or musculoskeletal systems, a 2.91% and 3.38% decrease, respectively, in acute care hospitalization rates could be obtained by providing patients with therapy and nursing services, rather than therapy services alone.

Cuidados de enfermería en la monitorización hemodinámica / Nursing cares in hemodynamic monitoring

No disponible

Development of a geriatric resuscitation protocol, utilization compliance, and outcomes.

Inconsistent application of trauma service resources and underevaluation of risk and resuscitation status in elderly trauma patients are problematic. We describe a geriatric protocol that includes initial lactate determination and trauma surgery admission. Protocol compliance rates were initial lactate determination, 67.9%; trauma service admission for overt or compensated (elevated lactate) shock, 73.6%; and trauma service consultation for nonshock patients, 67.8%. Implementation of this protocol resulted in a trend toward reduced mortality and reduced potentially preventable deaths.

Paciente quemado crítico cuidados iniciales / Critical burn patient. Nursing care

Las quemaduras constituyen hoy en día un importante problema de salud con repercusiones tanto para los pacientes que las sufren, como para las enfermeras que los cuidan. Pueden llegar a afectar muy seriamente la salud de los enfermos, alterando todo su organismo, incluso producirles la muerte. Para las enfermeras representan el cuidado de un paciente con una situación compleja, donde la valoración no es fácil y que necesita una atención integral, lo que exige una respuesta inmediata para evitar secuelas estéticas, funcionales y psíquicas, e incluso en ocasiones la muerte. Se pretende incidir en la importancia de efectuar una valoración integral, rápida y exhaustiva de quien sufre este tipo de lesiones, para actuar de manera inmediata en aquellas complicaciones que puedan provocarle la muerte(AU)

Burns are now a major elath problema with implications both for patients who suffer them, as for nurses who care for them. Burns can affect seriously the health of patients, can alter your entire body and cause the death. For nurses represent te care of a patient with a complex situation, where valuation is not easy and you need a comprehensive care, which requires an immediate response to prevent damage aesthetic, functional and psychological, and sometimes even death. It is intended to emphasized the importance of making a comprehensive assessment, rapid and comprehensive of those who suffer this type of injury, to act immediately on those applications that can cause death(AU)

Characteristics of patients receiving vasopressors.

BACKGROUND: Patients receiving intensive care frequently need pharmacologic support of their blood pressure because of shock. In some patients, shock is so severe that extremely high doses of vasopressors are needed to elevate their blood pressure. OBJECTIVE: We sought to ascertain the maximal dose of vasopressors administered to patients, and to describe the population of patients receiving vasopressors in one intensive care unit. METHODS: All adult patients admitted in 2001 to a 10-bed surgical unit in a university hospital, and receiving a vasopressor agent for 1 hour or more, underwent recordings of their demographic data, diagnoses upon admission, Acute Physiological and Chronic Health Evaluation (APACHE) II scores, vasopressors (including type, initial dose, dose increases, and maximal dose), number of days administered, complications, and mortality. RESULTS: Of 689 patients whose charts were reviewed, 72 received vasopressors. The mean age was 65 ± 21.4 years, and 66% were male. The mean APACHE II scores were 24 ± 6.2. The administration of .5 µg/kg/minute of norepinephrine or epinephrine resulted in 96% sensitivity and a specificity of 76% for the likelihood of mortality. Using Kaplan-Meyer curves, those patients receiving less than .5 µg/kg/minute demonstrated an 80% 6-year survival. All 17 patients receiving more than 3.8 µg/kg/minute of norepinephrine, and all 5 patients receiving more than 9.6 µg/kg/minute of epinephrine, died. The length of time during which patients received less than their maximal dose of vasopressors had no influence on survival (P = .4). The elderly (aged ≥ 75 years) and the young (aged <75 years) had the same intensive care unit survival rates when receiving vasopressors. CONCLUSION: In this study, little likelihood of intensive care unit survival was evident when patients received more than .5 µg/kg/minute of norepinephrine or epinephrine.

Consideraciones de enfermería sobre el niño con shock séptico en una Unidad de Alta Complejidad (UCIP) / Considerations of infirmary on the boy with septic shock in a Alta Unit Complejidad (UCIP)

El autor describe los diferentes tipos de shock, en particular el shock séptico en pediatría. Se realiza una presentación de caso clínico y su correspondiente Plan de Cuidados.

Understanding hypovolaemic, cardiogenic and septic shock.

Shock is a complex physiological syndrome. If it is not detected and treated promptly, it can lead to death. This article reviews and summarises the latest findings, treatment and nursing and medical interventions for three of the most common forms of shock, namely, hypovolaemic, cardiogenic and septic shock.