American journal of critical care : an official publication, American Association of Critical-Care Nurses
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Severe hemostatic defects that occur during massive transfusion are related to the volume of blood transfused, preexisting hemostatic abnormalities, concomitant pathologic changes, and therapeutic maneuvers. The relative role of each factor in the bleeding can be rapidly determined by using routine clinical laboratory tests. This determination requires an understanding of the properties of selected clotting factors, what coagulation screening tests measure, how these tests behave as the levels of factors change, and test profiles characteristic of different defects. ⋯ The pattern associated with hemodilution is universal in massive transfusion. Patterns characteristic of the other pathologic processes that may be encountered are simply superimposed on the characteristics of hemodilution. Successful management of the contributing causes of bleeding depends on the administration of the appropriate blood components in the dose necessary to ensure that the levels of platelets and clotting factors are returned to and maintained at hemostatic levels.
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Review
State of the science on parental stress and family functioning in pediatric intensive care units.
Critical illness of a child is stressful for parents and may affect family functioning. Most research on hospitalization in pediatric intensive care units has focused on the immediate responses of parents to the experience. ⋯ Further research is warranted on (1) families of various ethnic backgrounds; (2) fathers and their low participation rates; (3) mother and father comparisons; (4) replication of interventional research with larger and more diverse samples; (5) exploratory and prospective, longitudinal research; and (6) research with children in pediatric intensive care units.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effects of 3 analgesic regimens on the perception of pain after removal of femoral artery sheaths.
Effective pain management after removal of femoral artery sheaths after percutaneous transluminal coronary angioplasty is highly individualized and requires frequent, accurate assessment and administration of analgesics as needed. ⋯ For most patients, removal of femoral artery sheaths and manual compression for hemostasis are relatively pain-free. Pain scores among patients given analgesia with subcutaneous lidocaine, intravenous morphine, or intravenous fentanyl were not significantly different from pain scores among control patients.
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Little is known about nurses' perceptions of obstacles or helpful behaviors ("helps") in providing end-of-life care in the intensive care setting. ⋯ Nurses have difficulties with patients' families and physicians concerning end-of-life issues, especially when the behaviors remove the nurses from caring for a patient or cause the patient pain or prolong suffering. Nurses do not acknowledge having difficulty providing care to dying patients aside from conflicts that arise because of patients' families and physicians.