ABSTRACT
Patients with increased intracranial pressure generally require pharmacologic therapies and often more definitive treatments, such as surgical intervention. The overall goal of these interventions is to maintain or re-establish adequate cerebral blood flow and prevent herniation. Regardless of the cause of increased intracranial pressure, osmotherapy is considered the mainstay of medical therapy, and should be administered as soon as possible. This article reviews the history of hyperosmolar and hypertonic therapies, the Monro-Kellie hypothesis, and types of cerebral edema. Pharmacologic properties, clinical applications, complications, recommended monitoring during therapy, and risks versus benefits are also discussed.
Subject(s)
Fluid Therapy/history , Fluid Therapy/methods , Intracranial Hypertension/drug therapy , Mannitol/history , Mannitol/therapeutic use , Saline Solution, Hypertonic/history , Saline Solution, Hypertonic/therapeutic use , Adult , Aged , Aged, 80 and over , Female , History, 20th Century , History, 21st Century , Humans , Male , Middle AgedABSTRACT
Ultrasonography is a first-line diagnostic tool when evaluating volume status in the critical care patient population. Ultrasonography leads to a prompt diagnosis and more appropriate management plan, while decreasing health care costs, time to diagnosis, hospital length of stay, time to definitive operation, and mortality. It is recommended that critical care providers treating critically ill patients be skilled and competent in critical care ultrasonography. As the critical care population and the shortage of critical care physicians increases, advanced practice providers are becoming more prevalent in critical care areas and should be competent in this skill as well.
Subject(s)
Blood Volume Determination/methods , Critical Illness/therapy , Hypovolemia/diagnosis , Ultrasonography , HumansABSTRACT
BACKGROUND: Systems to meet the on-demand learning needs of nurses in intensive care units are not well studied beyond the traditional classroom models. OBJECTIVE: To study the feasibility and effect of implementing an online discussion forum for nurses in a busy neuroscience intensive care unit. METHODS: A baseline survey was done to highlight the areas of educational need in the unit. Freeform-a password-protected, online discussion forum supported by the university-was used for the pilot project. Freeform has functions similar to Facebook, with "likes," "follow," discussion/comment spaces, and the capacity for uploading images and files. A page called "All things NeuroCritical Care" was created. All nurses working in the intensive care unit were automatically enrolled. Clinical vignettes relevant to neurocritical care were posted once a month with 1 to 2 lead questions. All participation was voluntary, and topics were chosen on the basis of the needs survey. At the end of each case, a recent review article on the topic was posted for secure download. RESULTS: Eight sentinel diagnoses have been presented as clinical vignettes, and 34 of 76 members formally follow the page. The mean number of discussion strings per case is 8.3 posts. The number of unique visitors to the page during active case discussions exceeds 100. CONCLUSION: A secure, online, problem-based learning discussion format is a feasible point-of-care learning opportunity that can help overcome some of the traditional barriers to ongoing nursing education needs in a busy intensive care unit.
