La enfermería en cuidados intensivos / The infirmary in intensive critical care

Formación continua de enfermería en el área de cuidados intensivos. Organización de un Servicio de Terapia Intensiva. Oxigenoterapia. Ventilación no invasiva BIPAP. Asistencia respiratoria invasiva. Monitoreo hemodinámico. Atención al paciente con falla multiorgánica. Muerte digna en terapia intensiva?

La enfermería en cuidados intensivos / The infirmary in intensive critical care

Formación continua de enfermería en el área de cuidados intensivos. Organización de un Servicio de Terapia Intensiva. Oxigenoterapia. Ventilación no invasiva BIPAP. Asistencia respiratoria invasiva. Monitoreo hemodinámico. Atención al paciente con falla multiorgánica. Muerte digna en terapia intensiva?

Emergency department technicians in a university-county hospital: a 15-year experience.

Technicians have assisted physicians in many specialty areas in which a small number of procedures and limited expertise could be quickly mastered and used regularly. We describe a program of training and graded responsibility of emergency department technicians focusing on laceration and wound care, splinting, IV catheter placement, and other procedures for critically ill or injured patients. Infection rates of wounds sutured by technicians are comparable to those reported by physicians using similar techniques. In a time of nursing shortages, technicians are an alternative for supplementing the traditional providers of emergency care.

Prehospital use of intraosseous infusion by paramedics.

Vascular access in young children frequently proves difficult in the prehospital setting. To assess the feasibility of training paramedics in the placement of intraosseous (IO) lines as an alternative to intravenous (IV) access, this pilot project studied a training program and treatment protocol for prehospital IO use. Paramedics underwent a training program in IO placement. Patients enrolled were less than five years of age and in cardiac arrest. During a 10-month period, paramedics attempted 12 IO placements, of which 10 (85%) were successful, nine on the first attempt. Although no patients achieved long-term survival, three were initially resuscitated from arrest. Paramedics can be trained in IO placement, and IO infusion can be used in prehospital pediatric care. Training methods, limitations, and implications for future use are discussed.

The European diploma in anaesthesiology and intensive care.

An attempt has been made to outline the reasons for introducing this examination and the mechanics of running it. The examination is an international end-of-training examination and it is believed that it can play an important role in those countries where a national diploma does not exist but where anaesthesiologists responsible for training believe a postgraduate examination will contribute to training programmes. In addition, it has a role in easing the movement of anaesthesiologists between various European countries and helping to attain a uniformly high standard of training within the specialty.

Video recording trauma resuscitations: an effective teaching technique.

Since the initial hour after injury is the most crucial time for trauma patients, resuscitation technique is of vital importance. Standardized courses for first-hour management (ATLAS) have been widely accepted. A teaching format based upon video recording of every resuscitation has been developed. Tapes are reviewed by the staff and by the individuals involved in a particular resuscitation. In a weekly resuscitation review conference, actual footage is presented to the trauma team members, specific aspects of a resuscitation are critiqued, and supplemental didactic information is presented. Legal problems have been avoided by making the review and conference a part of the quality assurance process. Patient anonymity is preserved by positioning the video camera at the foot of the resuscitation bed. Tapes are erased after each conference. Video recording allows analysis of: 1) priorities during the resuscitation; 2) cognitive integration of the workup by the team leader; 3) physical integration of the workup by the team leader; 4) team member adherence to assigned responsibilities, resuscitation time, errors or breaks in technique; and 5) behavior change over time. In 3 1/2 years, more than 2,500 resuscitations have been recorded. Over a 3-month period, average resuscitation time to definitive care decreased for age- and injury severity-matched patient groups cared for by one team. Resuscitations have become more efficient and adherence to assigned responsibilities better. Weekly review of resuscitation contributes to improved technique and trauma care.

A survey of successful FFARACS candidates in Australasia.

As of October 1985, 37 candidates have passed the final examination in intensive care for the Diploma of Fellow of the Faculty of Anaesthetists, Royal Australasian College of Surgeons (FFARACS). In September 1984, 23 of these successful candidates responded to a questionnaire seeking information on their educational experiences during training and the nature of their work since the examination. At that time, six were staff specialists in anesthetic practice, one was involved in full-time intensive care research, one was the director of an accident and emergency center, and the remaining 15 were full-time staff specialists or senior registrars in intensive care. The responses to the questions on training indicated that more intensive care and medical experience were considered desirable. Most felt that their training and the examination were useful in determining long-term employment, satisfactory performance in intensive care, and personal job satisfaction.