AACN Advanced Critical Care最新文献

There are multiple opportunities for the use of ultrasonography in the diagnosis of skin and soft tissue differentials. Ultrasonography is inexpensive, easily reproducible, and able to provide real-time data in situations where condition changes and progression are common. Not only does bedside ultrasonography provide the clinician an in-depth look beyond epidermal structures into body cavities, it remains a safe, nonionizing radiating, effective, cost-efficient, reliable, and accessible tool for the emergency management of life- and limb-threatening integumentary infections. Unnecessary invasive procedures are minimized, providing improved patient outcomes. Integumentary abnormalities secondary to trauma, surgery, and hospitalization are common among critical care patients. This article provides a brief overview and evidence-based recommendations for the use of ultrasonography in the critical care setting for integumentary system conditions, including common skin and soft tissue differentials, foreign bodies, and burn depth assessment.

Background: Although cardiopulmonary resuscitation (CPR) renewal occurs every 2 years, quality of performed CPR at the study site was below American Heart Association (AHA) standards. Resuscitation Quality Improvement (RQI) is a new AHA program with the premise that practicing CPR more frequently using audiovisual feedback can improve performance.

Objective: To identify whether performance of chest compressions during training reassessments improves with RQI.

Methods: This study used a preintervention-postintervention design. Critical care nurses from 2 intensive care units performed a baseline round of chest compressions. These baseline data reflected CPR performance with traditional training. The next week, participants completed RQI training. Two weeks after RQI training, participants performed chest compressions. Five weeks after RQI training, participants performed a third round of chest compressions. The compressions performed 2 and 5 weeks after RQI used audiovisual feedback.

Results: Thirty nurses participated. Before intervention, the mean (SD) for overall compression compliance was 32.68% (26.96%), depth was 67.76% (30.15%), and rate was 39.95% (27.41%). The first postintervention (RQI plus 2 weeks) mean (SD) increased to 75.33% (33.70%) for overall compression compliance, 97.43% (12.04%) for depth, and 80.89% (29.35%) for rate. The second postintervention (RQI plus 5 weeks) mean (SD) decreased slightly to 73.16% (36.36%) for overall compression compliance, 96.57% (13.04%) for depth, and 78.75% (31.83%) for rate.

Conclusion: Frequent CPR using RQI technology, with its immediate audiovisual feedback, helps maintain skills, which may improve patient outcomes.

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.

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.