AACN Advanced Critical Care最新文献

Medical ultrasonography was first used as a diagnostic tool in 1942 by Theodore Karl Dussik to visualize brain structures. Use of ultrasonography broadened to the field of obstetrics in the 1950s and has since expanded to many other medical special-ties owing to ease of use, reproducibility, low cost, and lack of radiation. Advancements in ultrasonography technology have allowed clinicians to perform procedures with greater accuracy and to characterize tissue better than ever before. Piezoelectric crystals used to produce ultrasound waves have been replaced by silicon chips; artificial intelligence can be used to mitigate user variability; and more portable ultrasound probes are available for use with mobile devices. Ultrasonography requires training to be used appropriately, and patient and family education are crucial when performing an examination. Although some data are available regarding the amount of training needed for users to reach proficiency, this topic remains controversial and no standard currently exists.

Background: Patients in the intensive care unit have the highest rate of hospital-acquired pressure injuries (HAPIs). In the United States, treatment of HAPIs costs an estimated $9.1 to $11.6 billion annually, with each occurrence adding an average of $10 708 to a patient's total hospital cost. In addition to their financial impact, pressure injuries negatively affect patients physically, socially, and psychologically and are associated with increased morbidity and mortality.

Objective: An intensive care unit had 42 HAPIs during a single fiscal year, with 45% of them related to lack of adherence to the institution's established evidence-based skin care protocol. This project was conducted to increase adherence to the protocol and thus reduce the incidence of HAPIs in the unit.

Methods: This quality improvement initiative featured an evidence-based multifaceted intervention to increase adherence to the skin care protocol. A review of medical records was used to determine general skin care protocol adherence and to measure the monthly incidence of HAPIs in the unit.

Results: The number of HAPIs in the unit decreased from 33 in the preintervention period to 11 in the postintervention period, a reduction of 67%. The rate of general skin care protocol adherence improved to as high as 76% by the end of the postintervention period.

Conclusion: Use of an evidence-based multifaceted intervention can improve adherence to a skin care protocol in the intensive care unit, resulting in a reduced incidence of HAPIs and improved patient outcomes.

Both diabetic ketoacidosis and acute pancreatitis can result in critical illness. Although not the most common cause of acute pancreatitis, hypertriglyceridemia can account for up to 10% of cases. One source of hypertriglyceridemia is unrecognized diabetes and resultant hyperglycemia. Identifying the underlying cause of acute pancreatitis can guide the most appropriate therapy to resolve this critical illness. This case report addresses the use of insulin infusions to treat hypertriglyceridemia-induced pancreatitis in the setting of concomitant diabetic ketoacidosis.

Sodium-glucose cotransporter-2 inhibitors are now considered second-line treatment agents for type 2 diabetes and offer a unique treatment approach with added cardiorenal benefits. Drugs in this class increase the risk of euglycemic diabetic ketoacidosis, which may be difficult to diagnose if clinicians are not aware of the risk factors and subtle symptoms. This article describes a case of euglycemic diabetic ketoacidosis in a patient with coronary artery disease who was taking a sodium-glucose cotransporter-2 inhibitor and experienced acute mental status changes immediately after heart catheterization.