AACN clinical issues
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Continuous ST-segment monitoring has been shown to be beneficial for patients with acute coronary syndromes as well as for other patients in the intensive care unit (ICU). This article reviews the significance and value of continuous ST-segment monitoring with emphasis on the value of 12-lead ST-segment monitoring across the continuum of care from the emergency department, to the cardiac catheterization laboratory, the ICU, and the telemetry unit.
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AACN clinical issues · May 2003
Case ReportsWorking with respiratory waveforms: how to use bedside graphics.
Respiratory waveform graphics packages are available on many ventilators. Despite the prevalence of the waveforms, accurate interpretation and clinical application are not widespread. In fact, many clinicians find the waveforms confusing and choose to ignore them. This article provides a straightforward description of how to interpret the waveforms and suggests ways that the information might be used to improve clinical outcomes.
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AACN clinical issues · May 2003
Review Case ReportsCapnography application in acute and critical care.
The use of capnography has expanded over recent years. Currently, capnography is used in a variety of acute care settings. This article describes what capnography is and how it is used. ⋯ The multiplicity of clinical indications include detection of pulmonary embolism as well as malpositioned endotracheal/tracheal, gastric, and small bowel tubes. Capnography also provides clinicians with information regarding expiratory breathing patterns and assists in perfusion assessments such as those for cardiopulmonary resuscitation. Finally, case studies are provided to help the reader apply the concepts of capnography to a variety of acute care settings.
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The resuscitation of critically ill patients frequently requires the administration of fluids for the purpose of increasing cardiac output and oxygen delivery to the tissues. The assessment of the patient's preload status during this process is vital. Traditionally, preload assessment has been through the use of right atrial pressure and pulmonary artery occlusion pressure, which are often referred to as the "filling pressures." The use of these filling pressures is based upon the assumption that ventricular compliance does not change. ⋯ The volumetric parameters are presented followed by a discussion of research supporting the use of the volumetric parameters in lieu of pressure measurements for preload assessment in a variety of patient populations. The technology providing continuous RVEDV measurements is presented followed by a discussion of a case study demonstrating the value of continuous measurements. Specific implications for the advanced practice nurse are addressed.
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AACN clinical issues · May 2003
Review Case ReportsContinuous nervous system monitoring, EEG, the bispectral index, and neuromuscular transmission.
In critically ill patients, the central nervous system remains vulnerable to multiple insults including ischemia, hemorrhagic events, and encephalopathy. The peripheral nervous system is vulnerable in the setting of neuro-muscular blockade (NMB), related drug-drug interactions, and drug-clinical state interactions. Optimal assessment of the nervous system is done by means of the clinical neurological examination. ⋯ Neuromuscular transmission (NMT) monitoring by means of peripheral nerve stimulation and assessment of the evoked response may be utilized, within the context of clinical assessment, to determine level of chemical paralysis and minimize dosing of NMB agents. This article explores utilization and differentiates technologies such as EEG, BIS, and NMT monitoring. Monitoring parameters are illustrated using a case study approach.