Heart & lung : the journal of critical care
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Recent evidence indicates that misdiagnosis of cardiac arrhythmias is a common occurrence in critical care and telemetry units. The present article addresses the problem by reviewing electrocardiographic criteria for diagnosing the arrhythmias and ischemic conditions of major importance in the critically ill patient including wide QRS complex tachycardias, bundle branch blocks, and ST segment monitoring after thrombolytic therapy and balloon angioplasty. In addition, the advantages and disadvantages of various monitoring leads are discussed with recommendations regarding the most ideal leads for detecting these arrhythmias of interest. Finally, practical suggestions are offered for improving the quality of bedside electrocardiographic monitoring.
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A major responsibility of the critical care practitioner is to assure adequate ventilation of the critically ill patient. The traditionally used methods for evaluating ventilation, such as physical examination and measurement of vital signs, are indirect. The most commonly used direct method, measurement of arterial carbon dioxide tension, is invasive and intermittent. ⋯ We review relevant respiratory physiology as a basis for understanding the value of capnography. The technology on which capnography is based is described with emphasis on methods of gas sampling, limitations of capnography, and features available on currently marketed instruments. Representative capnograms are presented and the data interpreted to enable the practitioner to determine when capnography is an appropriate monitor for the critically ill adult.
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As an acute episode of respiratory failure resolves for the patient who is receiving mechanical ventilation, the sometimes difficult task of resuming spontaneous ventilation begins. The resumption of spontaneous ventilation, commonly referred to as weaning, is often difficult for the patient with preexisting lung disease. ⋯ Weaning is conceptualized as a process of three phases: preweaning, weaning, and extubation. Important considerations during each phase are examined.
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Cardiopulmonary resuscitation (CPR) is a technique that saves lives and is a measure that critical care practitioners use without hesitation. Potential complications from CPR, however, include injury. The reported incidence of such injuries ranges from 21% to more than 65%. ⋯ Limiting these injuries is important. Discovering them in successfully resuscitated victims, however, is critical to long-term recovery and rehabilitation. As future techniques for CPR evolve, further research needs to focus on those techniques that limit the potential for injury.
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Review Case Reports
Treatment strategies in shock: use of oxygen transport measurements.
Shock has traditionally been categorized according to its cause. Shock can result from hemorrhage, primary cardiac failure, central nervous system failure, trauma, or sepsis. Therapeutic principles have been developed for each etiologic type. ⋯ These variables are easily calculated by using data obtained from pulmonary artery catheter and laboratory measurements. The physician or nurse caring for critical ill patients should have a thorough understanding of the rationale for the use of oxygen transport calculations and the methods of manipulating oxygen delivery. A simple explanation of these principles including the importance of hemoglobin, cardiac index, and percent saturation of hemoglobin and suggested treatment strategies are presented.