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Emergency intensive critical care

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https://www.readbyqxmd.com/read/28936996/caregiver-perceptions-on-intensive-care-a-qualitative-study-from-southern-india
#1
Shuba Kumar, Jony Christina, Anna Revathi Jagadish, John Victor Peter, Kurien Thomas, Thambu David Sudarsanam
BACKGROUND: Admission of a patient to an intensive care unit (ICU) can result in tremendous stress to family caregivers not only because of the need to provide physical and emotional support to the sick relative, but also due to the burden of decision-making on behalf of the critically ill person. We enquired about family caregivers' perspectives on intensive care, the challenges they faced with decision-making and their perceptions on the nature of their interactions with healthcare providers...
May 2017: National Medical Journal of India
https://www.readbyqxmd.com/read/28923013/pragmatic-clinical-trials-embedded-in-healthcare-systems-generalizable-lessons-from-the-nih-collaboratory
#2
Kevin P Weinfurt, Adrian F Hernandez, Gloria D Coronado, Lynn L DeBar, Laura M Dember, Beverly B Green, Patrick J Heagerty, Susan S Huang, Kathryn T James, Jeffrey G Jarvik, Eric B Larson, Vincent Mor, Richard Platt, Gary E Rosenthal, Edward J Septimus, Gregory E Simon, Karen L Staman, Jeremy Sugarman, Miguel Vazquez, Douglas Zatzick, Lesley H Curtis
BACKGROUND: The clinical research enterprise is not producing the evidence decision makers arguably need in a timely and cost effective manner; research currently involves the use of labor-intensive parallel systems that are separate from clinical care. The emergence of pragmatic clinical trials (PCTs) poses a possible solution: these large-scale trials are embedded within routine clinical care and often involve cluster randomization of hospitals, clinics, primary care providers, etc...
September 18, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28922339/incidence-and-risk-factors-of-anaesthesia-related-perioperative-cardiac-arrest-a-6-year-observational-study-from-a-tertiary-care-university-hospital
#3
Andreas Hohn, Jan-Nicolas Machatschek, Jeremy Franklin, Stephan A Padosch
BACKGROUND: In recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce. OBJECTIVES: To determine the incidences of perioperative cardiac arrest and rates of anaesthesia-related and anaesthesia-contributory cardiac arrest. Identification of pre-existing risk factors leading to perioperative cardiac arrest...
September 15, 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28917226/energy-intake-in-the-first-week-in-an-emergency-intensive-care-unit-may-not-influence-clinical-outcomes-in-critically-ill-overweight-japanese-patients
#4
Satomi Ichimaru, Maren Sono, Ryutaro Seo, Koichi Ariyoshi, Teruyoshi Amagai
BACKGROUND AND OBJECTIVES: The American Society for Parenteral and Enteral Nutrition recommends hypocaloric feeding for critically ill patients with a BMI of >=30.0 kg/m2. However, the cut-off value of obesity in Japan is BMI >25.0 kg/m2, due to the higher prevalence of type 2 diabetes mellitus, and cardiovascular risk factors, even at a lower BMI than in Western populations. Thus, the optimal energy intake for critically ill, overweight Asian patients is unknown. METHODS AND STUDY DESIGN: A retrospective chart review was conducted in patients with BMI of >=25...
2017: Asia Pacific Journal of Clinical Nutrition
https://www.readbyqxmd.com/read/28914111/analyzing-how-discursive-practices-affect-physicians-decision-making-processes-a-phenomenological-based-qualitative-study-in-critical-care-contexts
#5
Luigina Mortari, Roberta Silva
An intensive care unit (ICU) is a demanding environment, defined by significant complexity, in which physicians must make decisions in situations characterized by high levels of uncertainty. This study used a phenomenological approach to investigate the decision-making (DM) processes among ICU physicians' team with the aim of understanding what happens when ICU physicians must reach a decision about the infectious status of a patient. The focus was put on the identification of how the discursive practices influence physicians' DM processes and on how different ICU environments make different discursive profiles emerge, particularly when a key issue is at the center of the physicians' discussion...
January 1, 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
https://www.readbyqxmd.com/read/28912978/anoxic-brain-injury-presenting-as-pseudosubarachnoid-hemorrhage-in-the-medical-intensive-care-unit
#6
O'Dene Lewis, Samina Afreen, Supo Folaranmi, Marie Fidelia-Lambert, Vishal Poddar, Alicia Thomas
Anoxic encephalopathy is frequently encountered in the medical intensive care unit (ICU). Cerebral edema as a result of anoxic brain injury can result in increased attenuation in the basal cisterns and subarachnoid spaces on computerized tomography (CT) scans of the head. These findings can mimic those seen in acute subarachnoid hemorrhage (SAH) and are referred to as pseudosubarachnoid hemorrhage (pseudo-SAH). Pseudo-SAH is a diagnosis critical care physicians should be aware of as they treat and evaluate their patients with presumed SAH, which is a medical emergency...
2017: Case Reports in Critical Care
https://www.readbyqxmd.com/read/28902700/effectiveness-of-collaboration-between-emergency-department-and-intensive-care-unit-teams-on-mortality-rates-of-patients-presenting-with-critical-illness-a-systematic-review
#7
Kerchelle McDowald, Svetlana Direktor, Elizabeth A Hynes, Anna Sahadeo, Margaret E Rogers
BACKGROUND: The increasing volume of adult patients with critical illness entering emergency departments (EDs) burdens the resources of EDs worldwide. This subpopulation faces a high risk of mortality because they require specialized care which many EDs are not yet poised to deliver. An element crucial to delivering care and decreasing the mortality of critically ill patients in the ED is expert collaborative practice across disciplines. Several ED and intensive care unit (ICU) collaborative models exist including: emergency department intensive care units (EDICU) and medical emergency teams (MET)...
September 2017: JBI Database of Systematic Reviews and Implementation Reports
https://www.readbyqxmd.com/read/28900356/humidifiers-for-oxygen-therapy-what-risk-for-reusable-and-disposable-devices
#8
REVIEW
V La Fauci, G B Costa, A Facciolà, A Conti, R Riso, R Squeri
INTRODUCTION: Nosocomial pneumonia accounts for the vast majority of healthcare-associated infections (HAI). Although numerous medical devices have been discussed as potential vehicles for microorganisms, very little is known about the role played by oxygen humidifiers as potential sources of nosocomial pathogens. The purpose of this research was to evaluate the safety of the reuse of humidifiers by analysing the rate of microbial contamination in reusable and disposable oxygen humidifiers used during therapy, and then discuss their potential role in the transmission of respiratory pathogens...
June 2017: Journal of Preventive Medicine and Hygiene
https://www.readbyqxmd.com/read/28866974/the-plasma-lyte-148-v-saline-plus-study-protocol-a-multicentre-randomised-controlled-trial-of-the-effect-of-intensive-care-fluid-therapy-on-mortality
#9
Naomi E Hammond, Rinaldo Bellomo, Martin Gallagher, David Gattas, Parisa Glass, Diane Mackle, Sharon Micallef, John Myburgh, Manoj Saxena, Colman Taylor, Paul Young, Simon Finfer
BACKGROUND: 0.9% sodium chloride (saline) is the most commonly administered resuscitation fluid on a global basis but emerging evidence suggests that its high chloride content may have important adverse effects. OBJECTIVE: To describe the study protocol for the Plasma- Lyte 148 v Saline study, which will test the hypothesis that in critically ill adult patients the use of Plasma-Lyte 148 (a buffered crystalloid solution) for fluid therapy results in different 90-day all-cause mortality when compared with saline...
September 2017: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
https://www.readbyqxmd.com/read/28844234/using-simulation-to-improve-systems-based-practices
#10
Aimee K Gardner, Maximilian Johnston, James R Korndorffer, Imad Haque, John T Paige
BACKGROUND: Ensuring the safe, effective management of patients requires efficient processes of care within a smoothly operating system in which highly reliable teams of talented, skilled health care providers are able to use the vast array of high-technology resources and intensive care techniques available. Simulation can play a unique role in exploring and improving the complex perioperative system by proactively identifying latent safety threats and mitigating their damage to ensure that all those who work in this critical health care environment can provide optimal levels of patient care...
September 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28835267/workplace-violence-in-a-tertiary-care-israeli-hospital-a-systematic-analysis-of-the-types-of-violence-the-perpetrators-and-hospital-departments
#11
Sigal Shafran-Tikva, Revital Zelker, Zvi Stern, David Chinitz
BACKGROUND: Worldwide, there is a widespread and disturbing pattern of violence towards healthcare workers. However, violent occurrences in Israeli hospitals have often been unrecognized and underreported. Moreover, most studies have not sufficiently differentiated among the different types of violence. To examine the different types of violence experienced by nurses and physicians, the types of perpetrators and the specialty fields involved. METHODS: A quantitative questionnaire was used to assess the incidence of a "basket" of violent behaviors, divided into eight types of violent manifestations...
August 23, 2017: Israel Journal of Health Policy Research
https://www.readbyqxmd.com/read/28834108/influence-of-hang-time-and-location-on-bacterial-contamination-of-intravenous-bags-in-a-veterinary-emergency-and-critical-care-setting
#12
Julien Guillaumin, Nichole M Olp, Karissa D Magnusson, Amy L Butler, Joshua B Daniels
OBJECTIVE: To assess the rate of bacterial contamination of fluid and ports in intravenous bags in a veterinary emergency room (ER) and intensive care unit (ICU). DESIGN: Experimental model. SETTING: Ninety intravenous fluid bags of lactated balanced-electrolytes solution (1 L) hung in a university hospital. INTERVENTIONS: Bags were hung in 2 different locations in the ER (sink and bins) and one location in the ICU (sink) for 11 days...
September 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28811051/patient-blood-management-in-the-intensive-care-unit
#13
REVIEW
Aryeh Shander, Mazyar Javidroozi, Gregg Lobel
Patient Blood Management underscores a fundamental shift from a product-centered approach to a patient-centric approach through timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis, and minimize blood loss in an effort to improve patient outcome. In this concept, allogeneic blood transfusion is not viewed as the treatment of default for anemic patients, but one among many treatment modalities that should be weighed based on its merits-potentials risks and benefits-for the individual patient in the context of other alternatives...
July 31, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28806562/zika-virus-induced-neurological-critical-illness-in-latin-america-severe-guillain-barre-syndrome-and-encephalitis
#14
Ugarte Ubiergo Sebastián, Arenas Villamizar Angel Ricardo, Bruno C Alvarez, Angela Cubides, Angélica F Luna, Max Arroyo-Parejo, Cayri E Acuña, Agamenón V Quintero, Orlando Ch Villareal, Oscar S Pinillos, Elías Vieda, Manuel Bello, Susana Peña, Carmelo Dueñas-Castell, Gloria M V Rodriguez, Jorge L M Ranero, Rosa L M López, Sandra G Olaya, José C Vergara, Ana Tandazo, Juan P S Ospina, Igor M Leyton Soto, R A Fowler, John C Marshall
Zika virus (ZIKAV) is classically described as causing minor symptoms in adult patients, however neurologic complications have been recognized. The recent outbreak in Central and South America has resulted in serious illness in some adult patients. We report adult patients in Latin America diagnosed with ZIKAV infection admitted to Intensive Care Units (ICUs). METHODS: Multicenter, prospective case series of adult patients with laboratory diagnosis of ZIKAV in 16 ICUs in 8 countries. RESULTS: Between December 1st 2015 and April 2nd 2016, 16 ICUs in 8 countries enrolled 49 critically ill patients with diagnosis of ZIKAV infection...
August 9, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28800865/anaphylaxis
#15
REVIEW
Daniel LoVerde, Onyinye I Iweala, Ariana Eginli, Guha Krishnaswamy
Anaphylaxis is a systemic, life-threatening disorder triggered by mediators released by mast cells and basophils activated via allergic (IgE-mediated) or nonallergic (non-IgE-mediated) mechanisms. It is a rapidly evolving, multisystem process involving the integumentary, pulmonary, gastrointestinal, and cardiovascular systems. Anaphylaxis and angioedema are serious disorders that can lead to fatal airway obstruction and culminate in cardiorespiratory arrest, resulting in hypoxemia and/or shock. Often, these disorders can be appropriately managed in an outpatient setting; however, these conditions can be severe enough to warrant evaluation of the patient in the ED and in some cases, hospitalization, and management in an ICU...
August 8, 2017: Chest
https://www.readbyqxmd.com/read/28798922/practical-approach-to-the-patient-with-acute-neuromuscular-weakness
#16
REVIEW
Rajeev Nayak
Acute neuromuscular paralysis (ANMP) is a clinical syndrome characterized by rapid onset muscle weakness progressing to maximum severity within several days to weeks (less than 4 wk). Bulbar and respiratory muscle weakness may or may not be present. It is a common neurological emergency which requires immediate and careful investigations to determine the etiology because accurate diagnosis has significant impact on therapy and prognosis. Respiratory failure caused by neuromuscular weakness is considered as more critical than lung disease because its development may be insidious or subtle until sudden decompensation leads to life threatening hypoxia...
July 16, 2017: World Journal of Clinical Cases
https://www.readbyqxmd.com/read/28793384/factors-that-influence-care-priority-for-chest-pain-patients-using-the-manchester-triage-system
#17
Carine Lais Nonnenmacher, Ananda Ughini Bertoldo Pires, Vitor Monteiro Moraes, Amália de Fátima Lucena
AIMS AND OBJECTIVES: Analyze crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. BACKGROUND: Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. DESIGN: Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital...
August 9, 2017: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/28774702/candida-and-invasive-mould-diseases-in-non-neutropenic-critically-ill-patients-and-patients-with-haematological-cancer
#18
REVIEW
A L Colombo, J N de Almeida Júnior, Monica A Slavin, Sharon C-A Chen, Tania C Sorrell
Critically ill patients and patients with haematological cancer are HIV-negative populations at high risk of invasive fungal infections. In intensive-care units, candidaemia and intra-abdominal candidiasis predominate, but aspergillosis has emerged as a lethal, under-recognised cause of pneumonia. In patients with haematological malignancies or who have undergone stem-cell transplantations, pulmonary disease due to aspergillus and other mould diseases predominate. In this Series paper, we provide an update on risk assessment, new diagnostic strategies, and therapeutic approaches...
July 31, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/28772343/the-emergency-department-s-impact-on-inpatient-critical-care-resources
#19
Kyle J Gunnerson
Critical care is an expensive and limited resource in the United States. Estimates from more than a decade ago suggest that over $100 billion a year is spent on critical care services.(1) Over the past two decades, the number of patients presenting to the Emergency Department (ED) requiring critical care services has increased at a much higher rate than the growth in overall ED volume.(2,3) The proportion of ED patients requiring Intensive Care Unit (ICU) admission has increased 75% over the first decade of the twenty-first century...
August 3, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28771680/safety-and-efficacy-of-rescue-flexible-bronchoscopic-intubation-using-the-bentson-floppy-tip-guidewire-via-a-supraglottic-airway-in-critically-ill-children
#20
D Cross, A Nyman, P James, A Durward
Difficulty in tracheal intubation in paediatric intensive care patients is associated with increased morbidity and mortality. Delays to intubation and interruption to oxygenation and ventilation are poorly tolerated. We developed a safe and atraumatic tracheal intubation technique. A floppy-tipped guidewire and airway exchange catheter were placed to a pre-determined length under bronchoscopic guidance while oxygenation and ventilation was maintained via a supraglottic airway device (SAD). We performed a retrospective review of this technique on patients who were either known to have or who had an unexpected difficultly in intubation...
August 3, 2017: Anaesthesia
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