Shirshendu Sinha, Archish Kataria, Bhanu Prakash Kolla, Nuria Thusius, Larissa L Loukianova
Wernicke encephalopathy (WE) was first described by Carl Wernicke in 1881. WE is caused by thiamine deficiency. Alcoholism is the most common etiologic factor associated with WE in the United States, but it can occur in any patient with a nutritional deficiency state such as hyperemesis gravidarum, intestinal obstruction, and malignancy. WE is a clinical diagnosis. The common findings include mental status changes, ocular dysfunction, and a gait apraxia, present in only 10% of cases. Only a few cases of WE are diagnosed before death...
June 2019: Mayo Clinic Proceedings
William Krebs, Howard Werman, Jeffery Jackson, Karen A Swecker, Heidi Hutchison, Michael Rodgers, Scott Fulton, Christine Celeste Brenna, Julie Stausmire, Nancy Buderer, Alison M Paplaskas
OBJECTIVE: Ketamine for rapid sequence intubation (RSI) is typically dosed at 1 to 2 mg/kg intravenously. The need to ensure dissociation during RSI led some to administer ketamine at doses greater than 2 mg/kg. This study assessed associations between ketamine dose and adverse events. METHODS: This multisite, retrospective study included adult subjects undergoing RSI with intravenous ketamine. Subjects were categorized into 2 groups: a standard ketamine dose (≤ 2 mg/kg intravenously) or a high dose (> 2 mg/kg intravenously)...
January 2021: Air Medical Journal
Biff F Palmer, Juan Jesus Carrero, Deborah J Clegg, Gates B Colbert, Michael Emmett, Steven Fishbane, Debra J Hain, Edgar Lerma, Macaulay Onuigbo, Anjay Rastogi, Simon D Roger, Bruce S Spinowitz, Matthew R Weir
Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Despite various guidelines, no universally accepted consensus exists on best practices for hyperkalemia monitoring, with variations in precise potassium (K+ ) concentration thresholds or for the management of acute or chronic hyperkalemia. Based on the available evidence, this review identifies several critical issues and unmet needs with regard to the management of hyperkalemia. Real-world studies are needed for a better understanding of the prevalence of hyperkalemia outside the clinical trial setting...
November 4, 2020: Mayo Clinic Proceedings
Ashley Barlow, Brooke Barlow, Nancy Tang, Bhavik M Shah, Amber E King
TOPIC: This article reviews the management of intravenous fluids and the evaluation of volume status in critically ill adults. CLINICAL RELEVANCE: Intravenous fluid administration is one of the most common interventions in the intensive care unit. Critically ill patients have dynamic fluid requirements, making the management of fluid therapy challenging. New literature suggests that balanced salt solutions may be preferred in some patient populations. PURPOSE OF PAPER: The bedside critical care nurse must understand the properties of various intravenous fluids and their corresponding impact on human physiology...
December 1, 2020: Critical Care Nurse
Patrick McGrath, Brian Kersten, Maya R Chilbert, Caroline Rusch, Megan Nadler
OBJECTIVE: The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia. METHODS: This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem...
November 22, 2020: American Journal of Emergency Medicine
Loretta Aller
BACKGROUND: Health care trends including advanced technology, higher patient acuity, and shorter employment orientation have impacted the environment in which new-graduate nurses are entering the workforce. These issues are contributing to new nurses leaving the workforce prematurely. Theoretical foundations for nursing education need to be updated to better prepare graduates for entry into this burdened environment. PURPOSE: The purpose of this study was to explore, from the student perspective, the process of educational development into professional licensure-ready graduates...
July 2021: Nurse Educator
Clifford L Freeman, Christopher S Evans, Tyler W Barrett
Managing sedation in the ventilated emergency department (ED) patient is increasingly important as critical care unit admissions from EDs increase and hospital crowding results in intubated patients boarding for longer periods. The objectives of this review are 3-fold; (1) describe the historical perspective of how sedation of the ventilated patient has changed, (2) summarize the most commonly used sedation and analgesic agents, and (3) provide a practical approach to sedation and analgesia in mechanically ventilated ED patients...
June 2020: Journal of the American College of Emergency Physicians open
Barb Nickel
TOPIC: This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. CLINICAL RELEVANCE: Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis...
October 1, 2020: Critical Care Nurse
Jaimee Warren, Blake Cooper, Anton Jermakoff, Jonathan C Knott
No abstract text is available yet for this article.
September 2020: Academic Emergency Medicine
Joan Somes
No abstract text is available yet for this article.
July 2020: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
Wiphawadee Potisopha, Karen M Vuckovic, Holli A DeVon, Chang G Park, Patricia E Hershberger
BACKGROUND: In 2009, the window from symptom onset to administration of tissue plasminogen activator for acute ischemic stroke was extended from 3 to 4.5 hours. Yet no systematic review has addressed prehospital delay by sex for stroke symptoms since this change. PURPOSE: We aimed to (1) compare prehospital delay times-the time from symptom onset to hospital arrival-between women and men with acute stroke or transient ischemic attack and (2) summarize factors influencing prehospital delay by sex...
November 2020: Journal of Cardiovascular Nursing
Stephanie Meyer
No abstract text is available yet for this article.
June 1, 2020: Critical Care Nurse
K P Abhilash, H Acharya, J Dua, S Kumar, B Selvaraj, G Priya
Background: Although oxygen is one of the oldest drugs available, it is still one of the most inappropriately administered drugs leading to over utilization of this very expensive resource. Materials and Methods: This prospective observational study was done in a large emergency department (ED) in India. The pattern of oxygen usage was studied before and after the strict implementation of an oxygen treatment algorithm. The algorithm was taught to all doctors and nurses and its implementation was monitored regularly...
June 24, 2020: Journal of Postgraduate Medicine
Diwas Gnyawali, Manish Man Pradhan, Prem Raj Sigdel, Purushottam Parajuli, Sampanna Chudal, Sujeet Poudyal, Suman Chapagain, Bhoj Raj Luitel, Pawan Raj Chalise, Uttam Sharma, Prem Raj Gyawali
Introduction: Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods: This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching...
2020: Advances in Urology
Bruno Levy, Thomas Klein, Antoine Kimmoun
PURPOSE OF REVIEW: Data and interventional trials on vasopressor use during cardiogenic shock are scarce. Their use is limited by their side-effects and the lack of solid evidence regarding their effectiveness in improving outcomes. In the present article, we review the current use of vasopressor therapy during cardiogenic shock. RECENT FINDINGS: Two recent Cochrane analyses concluded that there was insufficient evidence to prove that any one vasopressor was superior to others in terms of mortality...
August 2020: Current Opinion in Critical Care
Eftihia Polyzogopoulou, Angelos Arfaras-Melainis, Vasiliki Bistola, John Parissis
PURPOSE OF REVIEW: Cardiogenic shock is a multifactorial and diverse entity in which inotropes are the cornerstone therapy. Although published clinical trials have focused on pharmacologic treatment of cardiogenic shock, there is lack of an established and widely accepted decision-making algorithm on the use of inotropic agents in cardiogenic shock. RECENT FINDINGS: The current review incorporates cardiogenic shock pathophysiology, inotropes and vasopressors pharmacodynamics...
August 2020: Current Opinion in Critical Care
Marc Pineton de Chambrun, Nicolas Bréchot, Alain Combes
PURPOSE OF REVIEW: Temporary circulatory support (TCS) devices are increasingly used as a salvage therapy for patients with refractory cardiogenic shock. The exact place of the different TCS devices in the management of cardiogenic shock patients remains unclear and intensely debated. This article provides an overview on new cardiogenic shock classification, currently available devices, place of TCS in the management of cardiogenic shock patients, and discusses the results of recent case series and trials in this setting...
August 2020: Current Opinion in Critical Care
Johan Lassus
PURPOSE OF REVIEW: Organ dysfunction is a key feature of cardiogenic shock. Active revascularization and contemporary management in intensive care has improved prognosis in cardiogenic shock, but mortality is still unacceptably high. This review will discuss the prevalence, manifestation, management and clinical impact of kidney and liver dysfunction in cardiogenic shock. RECENT FINDINGS: Patients with cardiogenic shock more frequently have several comorbidities that make them at risk of developing multiorgan failure, including renal and liver dysfunction...
August 2020: Current Opinion in Critical Care
Christopher M Garrison, Frank E Ritter, Benjamin R Bauchwitz, James Niehaus, Peter W Weyhrauch
Educators are challenged to prepare nurses to care for low-frequency, high-stakes problems such as trauma. Computer-based tutors provide a cost-effective teaching strategy without risking patient safety. Evidence for the efficacy of this type of instruction is limited; thus, we tested the learning outcomes of a tutor on trauma care knowledge with senior nursing students. Participants were randomly assigned to either the tutor or a control condition (textbook learning). Instructional design elements incorporated into the tutor included use of multimedia content, emphasis of key points, frequent quizzing with instant feedback, and unfolding case studies to summarize key concepts...
June 19, 2020: Computers, Informatics, Nursing: CIN
Robert Willmore
Cardiac arrest with a degree of concurrent hypothermia is not a rare presentation. This presentation, often in remote areas, poses a challenge for the prehospital physician because the cause of the arrest will significantly alter decision making and prognostication. Survival from cardiac arrest secondary to accidental hypothermia is significantly greater than that of normothermic arrests when appropriate triage and management decisions are made. The complexity of this decision benefits from a specific algorithm to follow in the event of such a casualty presenting...
May 2020: Air Medical Journal
2020-06-26 18:44:08
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