AACN advanced critical care
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Procalcitonin is a promising biomarker for antibiotic therapy because its levels rise and fall quickly with bacterial infections. A multidatabase literature search was reviewed with 3 primary prospective randomized control trials used in further analysis. ⋯ Short-term studies did not show a difference in the intensive care unit length of stay, infection relapse rate, superinfection rate, or multidrug-resistant bacteria rate between the procalcitonin-protocol and control group. Because procalcitonin-guided antibiotic therapy has been shown to reduce the duration of treatment with antibiotics in critically ill patients without worsening the mortality rate or other outcomes, the implementation of a procalcitonin-guided antibiotic therapy should be considered for patients with proven or highly suspected bacterial infections in the intensive care unit.
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Critically ill patients receiving palliative care at the end of life are at high risk for experiencing pain, dyspnea, and death rattle. Nearly all these patients are at risk for the development of delirium. Patients who are alert may experience anxiety. ⋯ Evidence-based interventions are offered for both prevention and treatment of pain, dyspnea, anxiety, and delirium. Death rattle does not produce patient distress, and current pharmacological treatment lacks an evidence base. Pain management has a robust evidence base compared to management of dyspnea, anxiety, and delirium among this population; well-designed, adequately powered studies are needed.
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Depending on the causative agent, the differential diagnosis for acute nontraumatic weakness presentation can range from life threatening to trivial. Practitioners' comfort and experience with the rapid identification and evaluation of presenting neurological deficits vary widely. Given this fact and the reality that neurological presentation of weakness is common, the potential for missed diagnosis increases. To enhance knowledge of potentially life-threatening or morbidity-inducing complications, this article provides a systematic framework for physical and diagnostic evaluation of the most common differentials for acute causes of nontraumatic weakness.
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Cardiac arrest in the immediate postoperative recovery period in a patient who underwent cardiac surgery is typically related to reversible causes-tamponade, bleeding, ventricular arrhythmias, or heart blocks associated with conduction problems. When treated promptly, 17% to 79% of patients who experience cardiac arrest after cardiac surgery survive to discharge. The Cardiac Advanced Life Support-Surgical (CALS-S) guideline provides a standardized algorithm approach to resuscitation of patients who experience cardiac arrest after cardiac surgery. The purpose of this article is to discuss the CALS-S guideline and how to implement it.
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Stroke is the fourth leading cause of death and the leading cause of significant, long-term disability in the United States. Clinicians' knowledge and use of evidence to guide the care of patients with ischemic stroke are paramount to improving patient outcomes. ⋯ The guideline provides 115 recommendations for the management of patients with acute ischemic stroke, including 24 new recommendations and 51 revised recommendations divided into 14 major topic areas. This article reviews the recommendations and related literature and provides suggestions for use and implementation of the guideline within a stroke program of care.