Journal of critical care
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Journal of critical care · Dec 2013
Severe hyperkalemia can be detected immediately by quantitative electrocardiography and clinical history in patients with symptomatic or extreme bradycardia: A retrospective cross-sectional study.
Detecting severe hyperkalemia is challenging. We explored its prevalence in symptomatic or extreme bradycardia and devised a diagnostic rule. ⋯ Severe hyperkalemia is prevalent in symptomatic or extreme bradycardia and detectable by quantitative electrocardiographic parameters and history.
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Journal of critical care · Dec 2013
Analysis of the variations between Accreditation Council for Graduate Medical Education requirements for critical care training programs and their effects on the current critical care workforce.
Adult critical care medicine (CCM) is ill prepared for the demands of an aging US population. Sources have acknowledged a severe shortage of intensivists, yet there has been minimal discussion on the lack of critical care training opportunities. Inconsistencies in training options have led to fragmentation of how critical care services are provided to the US adult population. ⋯ Internal medicine offers the greatest pool of candidates to practice full-time CCM, yet there are minimal opportunities for internists wanting to go into straight CCM without also receiving pulmonary training. However, because many PCCM physicians spend a significant amount of time outside critical care, current PCCM training options do not meet the demand for critical care physicians. In this article, we review the barriers to critical care training opportunities and expanding the intensivist workforce and propose reasonable and practical solutions.
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Journal of critical care · Dec 2013
Multicenter StudyFactors associated with timing of initiation of physical therapy in patients with acute lung injury.
Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation. ⋯ In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation.
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Journal of critical care · Dec 2013
ReviewInterprofessional care in intensive care settings and the factors that impact it: Results from a scoping review of ethnographic studies.
At the heart of safe cultures are effective interactions within and between interprofessional teams. Critical care clinicians see severely ill patients who require coordinated interprofessional care. In this scoping review, we asked: "What do we know about processes, relationships, organizational and contextual factors that shape the ability of clinicians to deliver interprofessional care in adult ICUs?" Using the 5-stage process established by Levac et al. (2010), we reviewed 981 abstracts to identify ethnographic articles that shed light on interprofessional care in the intensive care unit. ⋯ Overall, studies were of mixed quality, with an average (SD) score of 5.8 out of 10 (1.77). Insights into intensive care unit cultures include the importance of paying attention to workflow, the nefarious impact of hierarchical relationships, the mixed responses to protocols imposed from the top down, and a general undertheorization of sex and race. This review highlights several lessons for safe cultures and argues that more needs to be known about the context of critical care if quality and safety interventions are to succeed.