Critical care nursing clinics of North America
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A variety of neuromonitoring techniques are available to aid in the care of neurocritically ill patients. However, traditional monitors lack the ability to measure brain biochemistry and may provide inadequate warning of potentially reversible deleterious conditions. ⋯ Its use is most frequently documented in traumatic brain injury and subarachnoid hemorrhage. Incorporating CMD into clinical practice is a multidisciplinary effort.
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Crit Care Nurs Clin North Am · Mar 2016
ReviewOptic Nerve Sheath Diameter Ultrasound and the Diagnosis of Increased Intracranial Pressure.
Ultrasound has been used for almost 30 years in a wide variety of clinical applications and environments. From the austerity of battlefields to the labor and delivery ward, ultrasound has the ability to give clinicians real-time, noninvasive diagnostic imaging. Ultrasound by emergency physicians (and all nonradiologists) has become more prevalent and has been used for examinations such as the transcranial Doppler to evaluate for stroke, cardiac function, FAST and EFAST examinations for trauma, and now increased intracranial pressure (ICP) via Optic Nerve Sheath Diameter Ultrasound (ONSD). The ONSD is a valid and reliable indicator of ICP.
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Advances in technology have resulted in a plethora of invasive neuromonitoring options for practitioners to manage while caring for the complex needs of the critical care patient. Although many types of invasive neuromonitoring are available to the practitioner, intraparenchymal monitors and external ventricular devices are used most frequently in the clinical setting and are the focus of this article. In addition, multimodality monitoring has been noted to confer a survival benefit in patients with this complex type of invasive neuromonitoring and is discussed as well.
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The neurologic examination (neuroexamination) is one of the most powerful tools available to nurses and physicians caring for patients with neurologic or neurosurgical illness. Assessing cranial nerve function is one of the most vital components of the neuroexamination. The pupillary light reflex helps to evaluate the status of the second and third cranial nerves and is one of the most well-known elements of the cranial nerve examination. Automated pupillometers have been developed that provide objective measures of size of the pupil and the responsiveness of the pupil to light (neuropupillary index).
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Crit Care Nurs Clin North Am · Dec 2015
ReviewCardiac Transplantation: Considerations for the Intensive Care Unit Nurse.
Heart transplantation is a recommended and curative treatment option for patients with advanced heart failure symptoms despite receiving optimal medical and device therapy. The availability of donor organs limits the number of patients able to receive a heart transplant. ⋯ Understanding the specific interventions and therapies unique to this patient population is critical to their care. This article reviews considerations for the intensive care unit clinician in the management of heart transplant patients in this setting.