Risk factors associated with pressure ulcer development in critically ill traumatic spinal cord injury patients.

Critically ill spinal cord injury (SCI) patients are at high risk for pressure ulcers. Research is needed to identify risk factors for pressure ulcers. The aim of this study was to investigate risk factors and outcomes of pressure ulcers in critically ill SCI patients. This is a retrospective cohort study. Data were gathered from medical records of adult patients with SCI admitted to surgical intensive care units. Ninety-four SCI patients participated in this study. Clinical variables associated with pressure ulcers were as follows: fecal management systems, incontinence, acidosis, support surfaces, steroids, and additional equipment. Hypotension was the strongest predictor of pressure ulcers. Nursing interventions may address risk factors and improve patient outcomes.

Hypothermia in the trauma patient: how vital is this sign?

Recognizing the adverse impact that trauma has on a patient's overall well-being and hemodynamic stability is key to successful management and improved outcomes for this patient population. It is well established that trauma is accompanied by deadly pathophysiological sequelae, referred to as the "trauma triad." This triad is characterized by hypothermia, acidosis, and coagulopathy. This triad is cyclic and, moreover, each element of the triad builds upon one another to exacerbate the next. Hence, evidence demonstrates that it is important to recognize the cycle and intervene early to reduce or prevent negative outcomes.

[The treatment of combat casualties today]. / La prise en charge des blessés de guerre aujourd'hui.

Most soldiers are wounded by an explosion and haemorrhaging is the main cause of death. From the first aid provided on the field of combat to repatriation to France, every stage in the treatment of injured soldiers is meticulously organised in order to save as many lives as possible.

Non-invasive ventilation: a nurse-led service.

Respiratory diseases are the third most common presentations to emergency departments (EDs) in the Republic of Ireland. Evidence suggests that early non-invasive ventilation (NIV) is often the treatment of choice, particularly for patients with chronic obstructive pulmonary disease. Therefore, having access to NIV in EDs is likely to improve patient outcomes and reduce the likelihood of their mechanical ventilation.

Development of an emergency department triage tool to predict acidosis among children with gastroenteritis.

OBJECTIVE: Design a triage assessment tool that predicts acidosis in children with vomiting, diarrhea, and dehydration. METHODS: A convenience sample of patients aged 3 months to 7 years with vomiting and/or diarrhea were enrolled in the triage area of a pediatric hospital's emergency department (ED). Caretakers of the eligible children completed a parental questionnaire assessing the patient's history of presenting illness. The triage nurse completed a 4-point physical examination assessment form. Collected information from the parental questionnaire and examination findings from the nurses' assessment were analyzed for factors that predicted acidosis in patients which was defined as having a serum bicarbonate level of 16 mmol/L or less or, if unavailable, an end-tidal carbon dioxide of 31 mm Hg or less. RESULTS: One hundred eighteen of the 130 patients enrolled had either a documented serum bicarbonate level or an end-tidal carbon dioxide and were therefore used in the final analysis for the primary outcome. Twenty-nine patients (25%) had acidosis. Univariate predictors of acidosis were younger age (mean [SD], 1.7 [1.4] vs. 3.1 [2.2] years, P = 0.002), previous evaluation by the primary care physician (62% vs. 33%, P = 0.008), being sent in by the primary care physician (66% vs. 33%, P = 0.002), and a worse overall appearance based on the triage nurse's mark on a 0-cm ("alert/playful") to 10-cm ("lethargic/limp") visual analog scale (3.7 [2.8] vs. 2.4 [2.2] cm, P = 0.013). A regression tree analysis identified age younger than 2 years, dry mucous membranes, and duration of illness more than 2 days as sequential factors predictive of patients at risk for acidosis. This decision tree identified patients with acidosis with an 89.7% sensitivity (95% confidence interval, 71.5%-97.3%) and a 93.6% negative predictive value (95% confidence interval, 81.4%-98.3%). CONCLUSIONS: The stepwise regression tree triage assessment tool dichotomizing patients based on age younger than 2 years, dry mucous membranes, and days of illness more than 2 days was able to predict acidosis with 90% sensitivity in patients presenting to the ED for evaluation of gastroenteritis. Identifying patients with acidosis early in their ED course allows the treating ED physician to focus more attention and resources toward rehydrating this at-risk population of patients with gastroenteritis.

Damage control surgery for the patient who has experienced multiple traumatic injuries.

PATIENTS WHO HAVE EXPERIENCED multiple traumatic injuries present one of the greatest challenges for perioperative teams. IN A TRAUMA PATIENT who is hemorrhaging, increased risk of death arises from a vicious cycle of hypothermia, coagulopathy, and metabolic acidosis known as the triad of death. A STAGED SURGICAL APPROACH predicated on specific priorities for treating multiply injured patients can help save the lives of these patients.

Challenges for nephrology nurses in the management of children with chronic kidney disease.

An important treatment goal for pediatric nephrology caregivers is the optimization of a child's capacity for normal growth and development. However, the physiologic and metabolic derangements associated with chronic kidney disease (CKD) significantly alter these processes, creating important challenges in the care of affected children. Evidence-based clinical practice guidelines support early recognition and treatment of CKD-related complications to improve growth and development and, ultimately, quality of life for children with this chronic condition.

Alcalosis metabólica y tratamiento con Diálisis Peritoneal. A propósito de un caso / Metabolic alcalosis and treatment with Peritoneal Dyalisi

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Using an algorithm to interpret arterial blood gases.

The arterial blood gas (ABG) analysis, one of the most common tests ordered, provides clinicians with valuable information on a patient's oxygenation and acid-base balance. Interpreting ABG analysis results can be challenging, even for the most experienced practitioners, because it requires knowledge of the physiology and cause-and-effect relationship of the disturbances. Applying the principles and the ABG algorithm described in this article will provide nurses with a systematic way to interpret uncomplicated arterial blood gas results, including primary, mixed, and compensated acidbase disturbances.

The trauma triad of death: hypothermia, acidosis, and coagulopathy.

With the organization of trauma systems, the development of trauma centers, the application of standardized methods of resuscitation, and improvements in modern blood banking techniques, the ability to aggressively resuscitate patients in extremis has evolved. The concept of the "golden hour" has translated into unprecedented speed and efficiency of trauma resuscitation with the ultimate goal of short injury-to-incision times. As the shift in care of patients in extremis has continued to move from the street to the emergency department and beyond, the focus of trauma resuscitation has shifted to the operating room and ultimately to the intensive care unit. The "new" golden hour may well be the time in the operating room before the patient reaches the physiologic limit, defined as the onset of the triad: hypothermia, acidosis and coagulopathy. Critical care nurses must understand this triad, because it forms the basis and underlying logic on which the damage control philosophy has been built. This article explores the pathogenesis and treatment of acidosis, hypothermia, and coagulopathy as it applies to the exsanguinating trauma patient.

Metabolic acidosis.

Metabolic acidosis is a pathophysiologic state that is associated with serious morbidities and mortality. The diagnosis of metabolic acidosis is perplexing for novice and expert advanced practice nurses for many reasons. Its differential diagnosis is broad and includes common and rare, complex disease. The diagnosis of metabolic acidosis is also difficult because it is frequently associated with mixed, acid-base disorders. Its clinical manifestations are often nonspecific or subclinical, which means that its diagnosis is made from laboratory and other diagnostic tests. Timely diagnosis of metabolic acidosis is needed to institute appropriate therapy to avoid negative physiologic effects.

Interpretation of arterial blood gases by nurses.

Many clinical nurses find the concept of acid/base balance confusing. This article presents a step-by-step approach to arterial blood gas (ABG) analysis. In addition, the components of ABGs (pH, PCO2 and HCO3) are presented; metabolic and respiratory abnormalities (acidosis and alkalosis) are discussed in relation to cause and signs and symptoms; the concept of compensation is reviewed; the degrees of compensation are explained; the five steps of ABG analysis are outlined; and practice problems are provided and explained. By using this approach, the nurse can analyze the ABG values confidently and make a wise choice about appropriate nursing actions.

A severe and fatal case of ethylene glycol poisoning.

A severe and fatal case of ethylene glycol (anti-freeze) poisoning in an unidentified vagrant man is reported and discussed. The case demonstrates the typical complications associated with this type of poisoning, in particular severe metabolic acidosis, acute renal failure and a deep comatose state. The importance of early diagnosis, aggressive treatment and intensive nursing care in order to optimize the chance of recovery are illustrated.