Point-of-care ultrasonography is becoming standard practice for diagnosis and management of patients in the critical care setting. When using point-of-care ultrasonography for evaluation of the abdomen, most providers will immediately think of the Focused Assessment with Sonography for Trauma examination. However, there are a number of important abdominal applications for the nontrauma patient, including evaluation of the function of abdominal organs, differentiation of shock states, and identification of sources of sepsis. This article covers basic approaches to an abdominal point-of-care ultrasonography examination of the biliary tract, liver, kidneys, bladder, and appendix, as well as identification and management of intra-abdominal free fluid.
{"title":"Point-of-Care Ultrasonography in the Critical Care Setting: Abdominal POCUS.","authors":"Bryan Boling, Abbye Solis","doi":"10.4037/aacnacc2023298","DOIUrl":"https://doi.org/10.4037/aacnacc2023298","url":null,"abstract":"<p><p>Point-of-care ultrasonography is becoming standard practice for diagnosis and management of patients in the critical care setting. When using point-of-care ultrasonography for evaluation of the abdomen, most providers will immediately think of the Focused Assessment with Sonography for Trauma examination. However, there are a number of important abdominal applications for the nontrauma patient, including evaluation of the function of abdominal organs, differentiation of shock states, and identification of sources of sepsis. This article covers basic approaches to an abdominal point-of-care ultrasonography examination of the biliary tract, liver, kidneys, bladder, and appendix, as well as identification and management of intra-abdominal free fluid.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 3","pages":"216-227"},"PeriodicalIF":2.2,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10110999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kimberly Albanowski, Kendall J Burdick, Christopher P Bonafide, Ruth Kleinpell, Joseph J Schlesinger
Ten years after the publication of a landmark article in AACN Advanced Critical Care, alarm fatigue continues to be an issue that researchers, clinicians, and organizations aim to remediate. Alarm fatigue contributes to missed alarms and medical errors that result in patient death, increased clinical workload and burnout, and interference with patient recovery. Led by the American Association of Critical-Care Nurses, national patient safety organizations continue to prioritize efforts to battle alarm fatigue and have proposed alarm management strategies to mitigate the effects of alarm fatigue. Similarly, clinical efforts now use simulation studies, individualized alarm thresholds, and interdisciplinary teams to optimize alarm use. Finally, engineering research efforts have innovated the standard alarm to convey information more effectively for medical users. By focusing on patient and provider safety, clinical workflow, and alarm technology, efforts to reduce alarm fatigue over the past 10 years have been grounded in an evidence-based and personnel-focused approach.
在AACN高级危重病护理发表里程碑式的文章十年后，警报疲劳仍然是研究人员、临床医生和组织致力于纠正的问题。警报疲劳导致错过警报和医疗错误，导致患者死亡，增加临床工作量和倦怠，并干扰患者康复。在美国重症护理护士协会(American Association of Critical-Care Nurses)的领导下，全国患者安全组织继续优先努力对抗警报疲劳，并提出了警报管理策略，以减轻警报疲劳的影响。同样，临床工作现在使用模拟研究、个性化警报阈值和跨学科团队来优化警报的使用。最后，工程研究工作对标准报警进行了创新，以更有效地向医疗用户传达信息。通过关注患者和提供者的安全、临床工作流程和警报技术，过去10年来减少警报疲劳的努力是基于循证和以人员为中心的方法。
{"title":"Ten Years Later, Alarm Fatigue Is Still a Safety Concern.","authors":"Kimberly Albanowski, Kendall J Burdick, Christopher P Bonafide, Ruth Kleinpell, Joseph J Schlesinger","doi":"10.4037/aacnacc2023662","DOIUrl":"https://doi.org/10.4037/aacnacc2023662","url":null,"abstract":"<p><p>Ten years after the publication of a landmark article in AACN Advanced Critical Care, alarm fatigue continues to be an issue that researchers, clinicians, and organizations aim to remediate. Alarm fatigue contributes to missed alarms and medical errors that result in patient death, increased clinical workload and burnout, and interference with patient recovery. Led by the American Association of Critical-Care Nurses, national patient safety organizations continue to prioritize efforts to battle alarm fatigue and have proposed alarm management strategies to mitigate the effects of alarm fatigue. Similarly, clinical efforts now use simulation studies, individualized alarm thresholds, and interdisciplinary teams to optimize alarm use. Finally, engineering research efforts have innovated the standard alarm to convey information more effectively for medical users. By focusing on patient and provider safety, clinical workflow, and alarm technology, efforts to reduce alarm fatigue over the past 10 years have been grounded in an evidence-based and personnel-focused approach.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 3","pages":"189-197"},"PeriodicalIF":2.2,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10117755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Point-of-care ultrasonography (POCUS) is a tool that can be used to evaluate critically ill obstetric patients, in the same way as for nonpregnant patients. With knowledge of the physiology and anatomical changes of pregnancy, POCUS can provide meaningful information to help guide clinical management. A POCUS cardiothoracic evaluation for left and right ventricular function, pulmonary edema, pleural effusion, and pneumothorax can be performed in pregnancy. A Focused Assessment with Sonography in Trauma examination in pregnancy is performed similarly to that in nonpregnant patients, and the information obtained can guide decision-making regarding operative versus nonoperative management of trauma. POCUS is also used to glean important obstetric information in the setting of critical illness and trauma, such as fetal status, gestational age, and placental location. These obstetric evaluations should be performed rapidly to minimize delay and enable pregnant patients to receive the same care for critical illness and trauma as nonpregnant patients.
{"title":"Point-of-Care Ultrasonography in the Intensive Care Unit for the Obstetric Patient.","authors":"Stephen Lammers, Cara D Dolin","doi":"10.4037/aacnacc2023934","DOIUrl":"https://doi.org/10.4037/aacnacc2023934","url":null,"abstract":"Point-of-care ultrasonography (POCUS) is a tool that can be used to evaluate critically ill obstetric patients, in the same way as for nonpregnant patients. With knowledge of the physiology and anatomical changes of pregnancy, POCUS can provide meaningful information to help guide clinical management. A POCUS cardiothoracic evaluation for left and right ventricular function, pulmonary edema, pleural effusion, and pneumothorax can be performed in pregnancy. A Focused Assessment with Sonography in Trauma examination in pregnancy is performed similarly to that in nonpregnant patients, and the information obtained can guide decision-making regarding operative versus nonoperative management of trauma. POCUS is also used to glean important obstetric information in the setting of critical illness and trauma, such as fetal status, gestational age, and placental location. These obstetric evaluations should be performed rapidly to minimize delay and enable pregnant patients to receive the same care for critical illness and trauma as nonpregnant patients.","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 3","pages":"207-215"},"PeriodicalIF":2.2,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10117758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ultrasonography guidance can help make procedures safer and more effective, particularly in the intensive care setting. This article discusses techniques to optimize periprocedural ultrasonography and reviews common intensive care procedures for which ultrasonography can be used: vascular access procedures, paracentesis, thoracentesis, and pericardiocentesis.
{"title":"Ultrasonography-Guided Procedures in the Intensive Care Setting.","authors":"Jeffrey C Cruz, Mark Edelstein","doi":"10.4037/aacnacc2023551","DOIUrl":"https://doi.org/10.4037/aacnacc2023551","url":null,"abstract":"<p><p>Ultrasonography guidance can help make procedures safer and more effective, particularly in the intensive care setting. This article discusses techniques to optimize periprocedural ultrasonography and reviews common intensive care procedures for which ultrasonography can be used: vascular access procedures, paracentesis, thoracentesis, and pericardiocentesis.</p>","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 3","pages":"201-206"},"PeriodicalIF":2.2,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Update on the Treatment of Heparin-Induced Thrombocytopenia.","authors":"Sheriff Gbadamosi, Kristin L Feick","doi":"10.4037/aacnacc2023462","DOIUrl":"https://doi.org/10.4037/aacnacc2023462","url":null,"abstract":"","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 3","pages":"173-178"},"PeriodicalIF":2.2,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10117753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Measurement Strategies for The Joint Commission Health Care Disparities Standard: Defining Hospital-Based Requirements-Part 1.","authors":"Bradi B Granger, Jill Engel","doi":"10.4037/aacnacc2023668","DOIUrl":"10.4037/aacnacc2023668","url":null,"abstract":"","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 2","pages":"154-160"},"PeriodicalIF":2.2,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9600356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tenecteplase: A Review of Its Pharmacology and Uses.","authors":"Jenna Forry, Alyssa Chappell","doi":"10.4037/aacnacc2023558","DOIUrl":"10.4037/aacnacc2023558","url":null,"abstract":"","PeriodicalId":46461,"journal":{"name":"AACN Advanced Critical Care","volume":"34 2","pages":"77-83"},"PeriodicalIF":2.2,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9600359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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