Articles: critical-care.
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Physiotherapists are critically positioned to integrate education into patient care, including pain science education (PSE) to enhance management and outcomes. Anecdotally, many physiotherapists report difficulty providing PSE in private practice settings. Here, we aimed to explore current PSE use, knowledge, and barriers to implementation. ⋯ Physiotherapists were aware of over 100 PSE resources, with varying levels of perceived use/effectiveness, yet were largely unaware of educational strategies. Physiotherapists called for reduced complexity and greater ability to individualise PSE resources. Findings will guide improvements in PSE training/resources, to maximise physiotherapists' confidence and preparedness to effectively implement PSE.
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Pol. Arch. Med. Wewn. · Jan 2025
Choice of resuscitation fluids in critically ill adults: key messages from the European Society of Intensive Care Medicine 2024 clinical practice guideline.
The 2024 European Society of Intensive Care Medicine clinical practice guideline provide clinicians with evidence-based recommendations on intravenous fluid in critically ill adults across a range of common conditions. These guidelines aim to improve the practices of fluid therapy by adopting a global perspective that considers both clinical efficacy and resource utilization in diverse healthcare settings. The guidelines address three key questions: (1) albumin versus crystalloids, (2) balanced crystalloids versus isotonic saline, and (3) small-volume hypertonic solutions versus isotonic crystalloids. ⋯ Small-volume hypertonic solutions were not shown to provide significant advantages over isotonic crystalloids, leading to a preference for the latter based on very low certainty evidence. This review provides an overview of the guideline development process and a detailed summary of their recommendations, highlighting key considerations for clinical practice. The guidelines also identify critical evidence gaps in fluid therapy research, underscoring the need for future studies to refine and optimize fluid management strategies in critically ill patients.
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The storage of reusable medical devices (RMDs) is the final reprocessing phase and the step that directly precedes point-of-care delivery. Reusable medical devices, including surgical tools necessitating sterilization and semicritical devices such as endoscopes, undergo high-level disinfection. The rigorous reprocessing protocols and subsequent storage of RMDs are crucial in preserving their sterility and asepsis. This ensures they are available, clean, and safe for patient use, thereby significantly reducing the risk of surgical site infection. The stringent requirements for RMD storage are a testament to the critical role it plays in patient safety, making it a demanding task for health care organizations (HCOs) to comply with. These challenges are further amplified in austere environments. This integrative review aims to identify optimal storage practices, emphasize the critical importance of RMD storage in the Military Health System, and derive implications for policies and future considerations. ⋯ Although surgical teams' capabilities are crucial in delivering effective care in a dynamic environment, the management and storage of RMDs are equally essential. Numerous organizations have outlined rigorous guidelines for HCOs to comply with, which can be intensified in austere conditions. Ultimately, a commitment to integrating the literature and developing the groundwork for clinical practice guidelines can improve the safe storage of RMDs in both standard and austere environments.
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The U.S. military utilizes small, forward deployed surgical teams to provide Role 2 surgical care in austere environments. These small teams are intended to be able to perform damage control resuscitation and surgery in the event of a mass casualty incident. Our team set out to demonstrate a proof of concept evolution by utilizing 2 operating rooms concurrently with a single certified registered nurse anesthetist and single surgeon to maximize the temporal efficiency of care by performing 4 elective surgical cases staggered in 2 rooms while deployed on an amphibious warship. ⋯ In the setting of multiple injured combat patients, this time saved is enough for an additional damage control trauma operation. When time is the critical factor in preventing both morbidity and mortality, the ability of a deployed surgical team to coordinate concurrent surgical care is of paramount importance. This report can act as a template for future austere surgical teams who encounter multiple simultaneous surgical casualties.