The Impact of Geriatric-Specific Triage Tools Among Older Adults in the Emergency Department
As the aging population grows, emergency department (ED) service utilization among those 65 years and older is expected to rise. In 2017, it was estimated that approximately 49 million Americans were 65 years and older. Not surprisingly, the number of ED visits by older adults is also increasing, given that this population is more likely to have multiple comorbidities. Emergency department visits by older adults pose specific challenges in risk stratification and optimizing their care based on the use of geriatric-specific triage tools. The aim of this integrative review is to appraise the impact of geriatric-specific tria...
Source: Critical Care Nursing Quarterly - December 4, 2019 Category: Nursing Tags: Original Articles Source Type: research
Dexmedetomidine's Relationship to Delirium in Patients Undergoing Cardiac Surgery: A Systematic Review
This systematic review aims to determine the relationship between postoperative delirium and the use of dexmedetomidine in comparison with commonly used sedatives/analgesics in the postoperative cardiac surgery patient. A systematic literature search of PubMed plus, CINAHL, Scopus, and Ovid, and limited to the English language in the last 10 years, was performed. Randomized controlled trials, observational and retrospective studies, and meta-analyses with at least 1 delirium assessment tool were included. The search found 196 potential articles; however, only 12 met the criteria outlined. The systematic review revealed a d...
Source: Critical Care Nursing Quarterly - December 4, 2019 Category: Nursing Tags: Original Articles Source Type: research
Individualizing Glycemic Control in the Critically Ill
Hyperglycemia is a common phenomenon in critically ill patients, even in those without diabetes. Two landmark studies established the benefits of tight glucose control (blood glucose target 80-110 mg/dL) in surgical and medical patients. Since then, literature has consistently demonstrated that both hyperglycemia and hypoglycemia are independently associated with increased morbidity and mortality in a variety of critically ill patients. However, tight glycemic control has subsequently come into question due to risks of hypoglycemia and increased mortality. More recently, strategies targeting euglycemia (blood glucose ≤18...
Source: Critical Care Nursing Quarterly - December 4, 2019 Category: Nursing Tags: Original Articles Source Type: research
An Uncommon Cause of Chest Pain: Hypertriglyceridemia-Induced Pancreatitis
Chest pain is a common and high-risk chief complaint in the emergency department. There is an array of cardiac and non–cardiac-related conditions that could lead to this symptom. It is important for the clinician to have a broad perspective when treating patients complaining of chest pain so that dangerous and potentially life-threatening conditions are not overlooked. Here, we present one such cause of chest pain that can be detrimental if the clinician fails to correctly identify the underlying condition. A brief review of hypertriglyceridemia-induced acute pancreatitis is provided, and challenges faced by the treatmen...
Source: Critical Care Nursing Quarterly - December 4, 2019 Category: Nursing Tags: Original Articles Source Type: research
Surviving an Active Shooter Incident in the Intensive Care Unit
This article describes mass shooting scenarios in hospitals and offers some definitive ways to ensure survival of those involved. (Source: Critical Care Nursing Quarterly)
Source: Critical Care Nursing Quarterly - December 4, 2019 Category: Nursing Tags: Original Articles Source Type: research
Foreword
No abstract available (Source: Critical Care Nursing Quarterly)
Source: Critical Care Nursing Quarterly - December 4, 2019 Category: Nursing Tags: Foreword Source Type: research
Cardiac Dysfunction in Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome is a heterogenous condition with significant mortality and limited therapeutic options. Although hypoxic respiratory failure tends to be the hallmark of the disease, there can be significant cardiac compromise, particularly in the right ventricle. Echocardiography plays an important role in the early diagnosis and recognition of right ventricular dysfunction. Treatment of said dysfunction with mechanical ventilation strategies and therapies such as inhaled nitric oxide or extracorporeal membrane oxygenation remain poorly studied but offer potential salvage strategies. (Source: Critical C...
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Acute Respiratory Distress Syndrome From an Infectious Disease Perspective
This article encompasses the most common infectious etiologies of ARDS and their clinical presentations and management, along with commonly encountered infectious complications in such patients. (Source: Critical Care Nursing Quarterly)
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Mimics of Acute Respiratory Distress Syndrome
Acute respiratory distress syndrome (ARDS) was first described in 1967 by Ashbaugh and colleagues. Acute respiratory distress syndrome is a clinical syndrome, not a disease, and has no ideal definition or gold standard diagnostic test. There are multiple causes and different pathways of pathogenesis as well as various histological findings. Given these variations, there are many clinical entities that can get confused with ARDS. These entities are discussed in this article as “Mimics of ARDS.” It imperative to correctly identify ARDS and distinguish it from other diseases to implement correct management strategy. (Sour...
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Acute Respiratory Distress Syndrome Novel Therapies
Acute respiratory distress syndrome (ARDS) was first described in 1967. Since then, several landmark studies have been published that have greatly influenced the way we diagnose and treat patients with ARDS. Despite extensive research and advancements in ventilator strategies, moderate-severe ARDS has been associated with high mortality rates. Current treatment remains primarily supportive with lung-protective ventilation strategies. Pharmacological therapies that reduce the severity of lung injury in vivo and in vitro have not yet translated into effective clinical treatment options. Currently, the mortality rate of sever...
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Extracorporeal Membrane Oxygenation in ARDS
Extracorporeal membrane oxygenation (ECMO) has become a key tool in the management of cardiac and/or respiratory failure refractory to conventional management. Although ECMO has multiple indications, it has been widely studied for the management of acute respiratory distress syndrome in adults. ECMO provides rest and support while the damaged lungs heal. It is an invasive modality with risks of serious complications; therefore, clinicians should be vigilant during patient selection. Furthermore, users should be familiar with different components of the ECMO machinery and the management of different organ systems while pati...
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Mechanical Ventilation in ARDS
This article discusses the concepts of ventilator-induced lung injury, permissive hypercapnia, high-versus-low peep strategies, oxygenation goals, and recruitment strategies from a physiologic perspective and the major studies that produced recommendations for each. Newer concepts, such as driving pressure, are also discussed. (Source: Critical Care Nursing Quarterly)
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Paralytics, Sedation, and Steroids in Acute Respiratory Distress Syndrome
In this article, we discuss the literature behind the use of paralytics, sedation, and steroids in acute respiratory distress syndrome. We explore the controversies and discuss the recommendations for the use of these agents. (Source: Critical Care Nursing Quarterly)
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Prone Positioning in ARDS
Adult respiratory distress syndrome (ARDS) is a clinical entity characterized by hypoxemic respiratory failure in the setting of noncardiogenic pulmonary edema. It is associated with significant morbidity and mortality. Prone positioning is a beneficial strategy in patients with severe ARDS because it improves alveolar recruitment, ventilation/perfusion (V/Q) ratio, and decreases lung strain. The outcome is improved oxygenation, decreased severity of lung injury, and, subsequently, mortality benefit. In this article, we discuss the physiology of prone positioning on chest mechanics and V/Q ratio, the placement and maintena...
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
Acute Kidney Injury in the Context of Acute Respiratory Distress Syndrome
Acute kidney injury is a heterogeneous syndrome defined by rapid (hours to days) decline in the glomerular filtration rate leading to retention of metabolic waste products including creatinine and urea, resulting in declination of the body's ability to manage fluid status and acid-base regulation. Acute kidney injury is seen commonly in acute respiratory distress syndrome and this article will explore the relationship between the 2 entities. (Source: Critical Care Nursing Quarterly)
Source: Critical Care Nursing Quarterly - August 27, 2019 Category: Nursing Tags: Original Articles Source Type: research
