Heart & lung : the journal of critical care
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The advancements in surgical technique and perioperative care have significantly improved the survival of children with single ventricle (SV) congenital heart disease (CHD) over the past decade. The population who have undergone the Fontan operation are growing into adulthood and facing many unique challenges. Past research has focused on functional and neurodevelopmental outcomes with inferences made to health-related quality of life (HRQOL). ⋯ Questions still remain on how these patients will transition into adulthood and whether they will live normal productive lives. This article reviews the literature related to HRQOL in the SV subgroup of CHD. In addition, an overview of newly developed disease-specific HRQOL instruments is presented as well as limitations and future research in HRQOL of the SV Fontan population.
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Adverse responses to protamine sulfate have been identified for many years. The antigen-antibody response to protamine sulfate results in a type I anaphylactic reaction. ⋯ Several potential risk factors for adverse reactions to protamine have been identified, including insulin-dependent diabetes mellitus, vasectomy, allergy to fish, prior exposure to protamine sulfate, and the rate of infusion. A case study is presented, and strategies for improving patient outcomes are discussed.
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Review Case Reports
Pulmonary embolism presenting as syncope: case report and review of the literature.
Syncope as an initial presentation of pulmonary embolism occurs in about 10% of patients. A 68-year-old woman was admitted to the hospital with syncope. A right lower lobe infiltrate was found on a chest x-ray film, and results of a ventilation-perfusion scan were interpreted to mean that a high probability of pulmonary embolism existed. ⋯ Syncope as a presenting symptom of pulmonary embolism is difficult to diagnose. Physicians must be vigilant with patients who have syncope, because this symptom may be the "forgotten sign" of life-threatening pulmonary embolism. The need for prompt diagnosis is clear, because with appropriate treatment the majority of patients may survive.
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Review
Monitoring neuromuscular blockade in the intensive care unit: the peripheral nerve stimulator.
Traditionally, neuromuscular blocking agents (NMBAs) have been administered in the operating room as an adjunct to anesthetics. Recent studies in the United States have indicated that 98% of the anesthesiologists and critical care nurses surveyed use NMBAs at least occasionally. ⋯ Understanding the complexities of NMBAs and the absolute need for accurate monitoring techniques is imperative for clinicians. The purpose of this literature review is to evaluate current literature regarding monitoring techniques of NMBAs and to guide the advanced practice nurse's role in critical care.
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Review Case Reports
Pulmonary thromboendarterectomy: an advance in the treatment of chronic thromboembolic pulmonary hypertension.
A new surgical procedure, pulmonary thromboendarterectomy, provides innovation in the surgical management of chronic thromboembolic pulmonary hypertension. This article will provide an overview of the surgical procedure itself as well as preindications for surgery and postoperative management. A clinical case study of a patient who has experienced the surgical procedure will be shared to apply the care management techniques outlined in the article.