Crit Care Nurs Clin North Am
· 2023 Sep · PMID 37532378
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Pediatric pain has historically been difficult to assess and even more difficult to treat. It is encouraging that there is current research regarding pain control in pediatric patients that provide evidence for treating...Pediatric pain has historically been difficult to assess and even more difficult to treat. It is encouraging that there is current research regarding pain control in pediatric patients that provide evidence for treating pediatric pain. Patients in a pediatric intensive care setting demonstrate a great deal of patient variability with regard to patient diagnosis, age, developmental level, weight, and amount of pain control needed. The use of an evidence-based protocol for pediatric pain control can decrease variability in pain control and decrease potential adverse effects such as respiratory depression, constipation, withdrawal, delirium, and developmental delays while allowing for patient variability.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127379
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Traumatic events such as hospitalization of family members in the intensive care setting can influence communication interactions between health-care workers and family members not just because of the acute situation but...Traumatic events such as hospitalization of family members in the intensive care setting can influence communication interactions between health-care workers and family members not just because of the acute situation but because it brings feelings resulting from past traumatic events to the surface. Providing trauma-informed care to all patients and families in the critical care setting improves communication and results in encounters that are less likely to result in an escalation of negative emotions and outbursts and provides an environment that is conducive to interprofessional communication between families, patients, and health-care workers.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127378
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Social determinants of health (SDOHs) have been well studied within the literature in the United States but the effects of these determinants of health on patients with trauma have garnered less attention. The interactio...Social determinants of health (SDOHs) have been well studied within the literature in the United States but the effects of these determinants of health on patients with trauma have garnered less attention. The interaction between patients with SDOHs and patients with trauma requires clinicians caring for this population to view patients with trauma through a multifaceted lens. The purpose of this article will be to illuminate the drivers of trauma in the adult population and how the SDOHs and the health-care system come together to contribute to disparities in trauma outcomes.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127377
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The authors provide a concise, comprehensive overview of the unique anatomic and physiologic features of pregnancy as well as modification and considerations important for the management of the pregnant trauma patient.The authors provide a concise, comprehensive overview of the unique anatomic and physiologic features of pregnancy as well as modification and considerations important for the management of the pregnant trauma patient.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127376
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Traumatic injuries occur from unintentional and intentional violent events, claiming an estimated 4.4 million lives annually (World Health Organization). Abdominal trauma is a common condition seen in many trauma centers...Traumatic injuries occur from unintentional and intentional violent events, claiming an estimated 4.4 million lives annually (World Health Organization). Abdominal trauma is a common condition seen in many trauma centers accounting for roughly 15% of all trauma-related hospitalizations (Boutros and colleagues 35) and is associated with significant morbidity and mortality. Following the concepts of Damage Control Resuscitation can reduce mortality drastically. Ultrasound, computed tomography scans, and routine physical examinations are used to make prompt diagnoses, trend injuries, and recognize deterioration of clinical status. Clear, effective, and closed-loop communication is essential to provide quality care.
Cottrell DB, Aaron-Brija L, Berkowitz E
… +1 more, Williams J
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127375
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Trauma care is complex. Acute and critical care clinicians perceive trauma as a skilled response to critical injury or accident that occurs to patients, but trauma exists on many levels. One of those is a grim reality fo...Trauma care is complex. Acute and critical care clinicians perceive trauma as a skilled response to critical injury or accident that occurs to patients, but trauma exists on many levels. One of those is a grim reality for patients who are lesbian, gay, bisexual, transgender, queer or questioning, and from other sexual and gender minorities (LGBTQ+). A lifetime of trauma through stigma, discrimination, and victimization is too often present. Owing to distrust of the health care system and clinicians, LGBTQ+ experience health and health care disparities.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127374
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Traumatic brain injury (TBI) is a leading cause of death and disability in the United States, predominantly impacting men. The highest risk for the development of a TBI includes athletes, construction workers, military p...Traumatic brain injury (TBI) is a leading cause of death and disability in the United States, predominantly impacting men. The highest risk for the development of a TBI includes athletes, construction workers, military personnel, and law enforcement. TBI is classified as mild, moderate, or severe. The degree of TBI will determine the severity of clinical manifestations. Management of TBI may be a combination of operative and non-operative interventions. Nursing considerations and management include frequent assessment of vital signs and neurologic status, maintaining hemodynamic stability, early identification of worsening clinical manifestations, and psychosocial support to the TBI patient and family.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127373
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Falls in the ICU are multifaceted, affecting patients of all ages. Historically, falls have been associated with patients in the hospital environment, but fall rates after discharge and readmission rates following a fall...Falls in the ICU are multifaceted, affecting patients of all ages. Historically, falls have been associated with patients in the hospital environment, but fall rates after discharge and readmission rates following a fall are now areas of concern. Recent innovations to prevent risks related to sedation and immobility in the hospital have revealed their impact on ICU patients and fall risk. Risk factors for falls in the ICU relate to length of stay and acuity-related care requirements, such as mechanical ventilation, sedation, and prolonged immobilization. Evidence-based fall prevention includes screening tools, prevention bundles/programs, and implementing clinical practice guidelines.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127372
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Geriatric trauma is increasing in the United States. The care of patients with geriatric trauma is complex due to age-related changes and comorbidities. Patients with geriatric trauma have increased risk of poor outcomes...Geriatric trauma is increasing in the United States. The care of patients with geriatric trauma is complex due to age-related changes and comorbidities. Patients with geriatric trauma have increased risk of poor outcomes compared with younger patients with trauma, and the highest risk groups are those who have frailty. These patients require special care considerations. Multidisciplinary care can improve outcomes in frail patients with geriatric trauma.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127371
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A patient with trauma presents a unique and/or complex challenge to the ethical foundation that guides nursing care. Patients with trauma, by the very nature of the suddenness of their injury, are unable to predetermine...A patient with trauma presents a unique and/or complex challenge to the ethical foundation that guides nursing care. Patients with trauma, by the very nature of the suddenness of their injury, are unable to predetermine or express their wishes in the event of a catastrophic injury. The providers who care for patients with trauma do not have an established patient relationship to aid them in decision-making based on what they think the patient would wish or based on past conversations. Yet, they provide expert care and use ethical principles to direct their professional responsibility to these patients.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127370
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The challenge in caring for patients who sustain traumatic chest injuries centers on their complex needs from high acuity and the potential for multisystem effects and complications. Hemorrhage and respiratory compromise...The challenge in caring for patients who sustain traumatic chest injuries centers on their complex needs from high acuity and the potential for multisystem effects and complications. Hemorrhage and respiratory compromise are common sequela of thoracic trauma. Patients must be resuscitated and their injuries managed with the primary goals of restoring cardiopulmonary structural integrity and preventing complications. There are evolving strategies for the management of the thoracic trauma victim including damage control resuscitation and surgery, endovascular repairs, and assessments implementing severity scores to aid in planning interventions.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127369
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Traumatic cervical spinal cord injury can cause significant neurologic disability. A cervical spine injury impacts not only the neurologic system but also numerous other organ systems of the body. This complex injury req...Traumatic cervical spinal cord injury can cause significant neurologic disability. A cervical spine injury impacts not only the neurologic system but also numerous other organ systems of the body. This complex injury requires a systematic approach to assessment and care aimed at preventing, recognizing, and treating potentially devastating secondary spinal cord injury and multisystem complications. This article focuses on the pathophysiology, initial presentation, and treatment of cervical spinal cord injury by body system.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127368
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Airway assessment and management is the first priority in trauma care. The airway can be compromised by traumatic injuries or altered mentation. Airway assessment is conducted during the primary survey. Airway triage in...Airway assessment and management is the first priority in trauma care. The airway can be compromised by traumatic injuries or altered mentation. Airway assessment is conducted during the primary survey. Airway triage in trauma is determined by patient and environmental factors. Initial interventions include positioning maneuvers and suction to clear the airway with supplemental oxygen. Endotracheal intubation and surgical (or "front of neck") airways are considered definitive. Traumatic airway injuries are rare but have high mortality and morbidity if undetected.
Crit Care Nurs Clin North Am
· 2023 Jun · PMID 37127367
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Trauma remains a leading cause of death among adults. Care of the trauma patient requires highly skilled trauma teams. Trauma care begins in the field, then presents to the emergency room, proceeds to intensive care in m...Trauma remains a leading cause of death among adults. Care of the trauma patient requires highly skilled trauma teams. Trauma care begins in the field, then presents to the emergency room, proceeds to intensive care in many cases, and finally reaches recovery and rehabilitation. For patients, it can be a long road. To be effective, multidisciplinary trauma teams must expertly drill and practice skills, communicate among team members in closed loops, make split decisions affecting patient outcomes, and see the care through to the end. Many disruptions during the course of providing trauma care can alter safe outcomes for patients. The American Association of Critical Care Nurses Six Essentials of the Healthy Work Environment are presented as a framework to provide excellence in trauma care, both for the patient and team members. The six essentials of a healthy work environment include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774010
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Despite contemporary rehabilitation strategies, stroke remains a leading cause of loss of function, limited mobility, psycho-social complications, and decreased quality of life. Stroke rehabilitation is a process that ai...Despite contemporary rehabilitation strategies, stroke remains a leading cause of loss of function, limited mobility, psycho-social complications, and decreased quality of life. Stroke rehabilitation is a process that aims to prevent deterioration of function, increase function, and assist the patient in achieving the highest possible level of independence physically, socially, spiritually, psychologically, vocationally, and economically. The process begins with relearning activities of daily living such as grooming, bathing, toileting, eating, and dressing. As the patient progresses, stroke rehabilitation works on instrumental activities of daily living such as housekeeping, cooking, driving, and managing financial responsibilities.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774009
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With advances in technology, the options to manage patients with neurologic injuries are often complex. Critical care management of neurologic injury has historically focused on the prevention of secondary ischemic injur...With advances in technology, the options to manage patients with neurologic injuries are often complex. Critical care management of neurologic injury has historically focused on the prevention of secondary ischemic injury through aggressive management of intracranial pressure (ICP) and maintenance of adequate cerebral perfusion pressure (CPP). However, ICP monitoring alone does not identify ischemic changes that herald patient deterioration. Advocates of multimodality monitoring cite the value of early detection of changes in brain oxygenation levels and brain metabolism as advantageous in optimizing stroke outcomes. ICP monitoring alone should not be the sole source of information on which therapy is guided but should be incorporated into the arsenal of emerging and promising invasive neuromonitoring devices.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774008
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Decompressive hemicraniectomy (DHC) is a life-saving procedure involving removal of large portions of the skull to relieve intracranial pressure in patients with space occupying cerebral edema such as traumatic brain inj...Decompressive hemicraniectomy (DHC) is a life-saving procedure involving removal of large portions of the skull to relieve intracranial pressure in patients with space occupying cerebral edema such as traumatic brain injury (TBI) and stroke. Although the procedure has been shown to decrease mortality in patients, the risk of severe disability is significant. Quality of life, not just survival, following DHC has emerged as an important consideration when the decision is made to perform a DHC.
Crit Care Nurs Clin North Am
· 2023 Mar · PMID 36774007
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Full text
Since the intial outbreak of the coronavirus-2019 (COVID-19) in December 2019, a variety of neurologic manifestations have been linked to this virus, including stroke. Comprehensive review of worldwide studies using vari...Since the intial outbreak of the coronavirus-2019 (COVID-19) in December 2019, a variety of neurologic manifestations have been linked to this virus, including stroke. Comprehensive review of worldwide studies using various methodologies indicated a correlation of increased stroke risk in patients with COVID-19. The literature reivew also revealed increased morbidity and mortality among patients with COVID-19 and stroke as compared to those with only stroke. This pandemic, with its related healthcare staffing shortages, revealed the requisite to utilize innovative technologies such as Tele-Neurology, as well as public health campaigns focusing on stroke recognition and early treatment.