AACN advanced critical care
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Review
Recombinant factor VIIa: review of current "off license" indications and implications for practice.
Uncontrolled bleeding and coagulopathy are associated with trauma, liver failure, obstetric conditions, and a variety of surgical circumstances, resulting in increased morbidity and mortality in the critically ill. Recently, the role of recombinant factor VIIa (rFVIIa) in the management of uncontrolled bleeding has attracted interest. rFVIIa was initially developed (and licensed) for the treatment of hemophilia. ⋯ Recently, the first randomized controlled trial of rFVIIa in trauma patients reported a significant reduction in red blood cell transfusion, and a trend toward reduced mortality and critical complications. As evidence builds to support the use of rFVIIa, nurses need to be aware of the administration and safety issues of this treatment.
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Hospitals, especially their intensive care units, are not particularly safe for patients. Life-threatening mistakes and omissions in care can and do occur. To deter omissions and mistakes wherever possible, our medical intensive care team developed a checklist of care issues that must be addressed daily for every patient in our intensive care unit. ⋯ It is too soon to tell whether the checklist has had an impact on our survival rate or length of stay, but we have documented clear improvement in our attention to these core intensive care issues. In addition, our team's collegiality and team bonding are enhanced by using an evidence-based tool to achieve our care goals. We share our checklist, so that others can use and/or adapt it in their pursuit of optimal care for their critically ill patients.
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The use of rapid response teams is a relatively new approach for decreasing or eliminating codes in acute care hospitals. Based on the principles of a code team for cardiac and/or respiratory arrest in non-critical care units, the rapid response teams have specially trained nursing, respiratory, and medical personnel to respond to calls from general care units to assess and manage decompensating or rapidly changing patients before their conditions escalate to a full code situation. This article describes the processes used to develop a rapid response team, clinical indicators for triggering a rapid response team call, topics addressed in an educational program for the rapid response team members, and methods for evaluating effectiveness of the rapid response team.
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Critical illness polyneuromyopathy, a complication of critical illness, is a primary axonal degeneration of motor and sensory fibers that leads to skeletal muscle weakness. It significantly contributes to the unexplained difficulty in weaning from mechanical ventilation and to their prolonged rehabilitation and poor quality of life after discharge. This article will discuss the diagnosis of critical illness polyneuromyopathy, identify risk factors, review several pathomechanisms that have been proposed, and discuss the implications for practice.