Heart & lung : the journal of critical care
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Central venous catheters are used widely for a variety of therapeutic purposes and have an increased incidence of infections related to their use. The purpose of this article is to address the issue of central venous catheter-related infections, including pathogenesis, predictors and diagnosis, and prevention.
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Review Comparative Study
Determination of oral temperature accuracy in adult critical care patients who are orally intubated.
To determine whether sublingual temperatures are accurate in adult critical care patients with an oral endotracheal tube in place. ⋯ Sublingual and pulmonary artery temperature measurements of adult critical care patients who were orally intubated consistently showed close agreement during a thermally dynamic 8-hour period after open-heart surgery.
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To determine if the phlebostatic axis (PA) can be used to obtain reproducible central venous pressures (CVP) in laterally positioned critically ill patients. ⋯ Of the three leveling procedures, the supine PA yielded the most reproducible CVP measures. However, further studies are required before the supine PA can be recommended as a valid and reliable transducer position for CVP measurement in laterally positioned patients.
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The objective of this study was to review current changes in the pharmacologic management of cardiac arrest (ventricular fibrillation, pulseless ventricular tachycardia, asystole, and electromechanical dissociation) as put fourth by the American Heart Association's 1992 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care. We concluded that the 1992 Guidelines provide a reference base for all clinicians involved in emergency cardiac care. The newly revised recommendations are classified on the basis of the true clinical merit of the intervention, for example, an intervention that has been proved effective (i.e., high-dose epinephrine) versus one that is possibly effective (i.e., high-dose epinephrine). ⋯ Magnesium sulfate has been added for the management of torsades de points, severe hypomagnesemia, or refractory ventricular fibrillation. The maximum total dose of atropine in the treatment of asystole and electromechanical dissociation has been increased from 2 mg to 0.04 mg/kg. The use of sodium bicarbonate should be limited to the treatment of hyperkalemia, tricyclic antidepressant overdose, overdoses requiring urinary alkalinization, or preexisting bicarbonate sensitive acidosis.
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Review Comparative Study
Pharmacodynamics, pharmacokinetics, and clinical uses of fentanyl, sufentanil, and alfentanil.
To review the basic and clinical pharmacology of three opioids to assist in the nursing care of postoperative patients. ⋯ Fentanyl, sufentanil, and alfentanil are potent synthetic opioids that are used for anesthesia and postoperative analgesia. The advantages of these opioids compared with morphine are short duration of action, lack of hyperglycemic response to surgery, decrease in catecholamine levels, and high lipid solubility. The nursing care of patients receiving these opioids involves frequent assessment of the degree of analgesia and monitoring for and treatment of side effects.