RESUMO
Residual neuromuscular blockade is a widespread challenge for providers in the acute care setting that, if left unrecognized or untreated, places patients at higher risk for morbidity and mortality. The condition is estimated to occur in 26% to 88% of patients undergoing general anesthesia. The role of the advanced practice nurse in the acute care setting is to facilitate a safe recovery process by identifying early signs of deterioration and supporting the patient until full muscular strength has returned. This article discusses the prevalence of residual neuromuscular blockade and associated complications and patient risk factors. A review is included of the current uses for neuromuscular blockade, pathophysiology of the neuromuscular junction, pharmacologic characteristics of neuromuscular blocking agents (including drug-drug interactions), monitoring modalities, and effectiveness of reversal agents. Treatment recommendations pertinent to residual neuromuscular blockade are outlined.
Assuntos
Enfermagem de Cuidados Críticos/métodos , Recuperação Demorada da Anestesia/etiologia , Recuperação Demorada da Anestesia/enfermagem , Bloqueio Neuromuscular/enfermagem , Bloqueadores Neuromusculares/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Educação Continuada em Enfermagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como AssuntoRESUMO
Therapeutic hypothermia has been shown to improve neurological outcomes for patients who survive cardiac arrest. Timely cooling can be achieved by rapid initiation of a comprehensive targeted temperature protocol, which includes shivering assessment and management. The purpose of the study was to evaluate an updated therapeutic hypothermia protocol for patients who survive cardiac arrest. The first 6 patients who met inclusion criteria were placed on the updated protocol. These cases were compared with historical cases. Upon discharge or death, cases were analyzed for time to reach the target temperature, the use of paralytic agents, and discharge disposition. Patients placed on the updated protocol cooled 2 hours faster than did the patients from the historical cases (median = 179 vs 285 minutes). The use of paralytic agents appeared to safely accelerate the time to goal temperature. Four of the 6 patients were discharged home or to rehabilitation compared with only 1 patient from the historical cases. Implementing this evidence-based protocol for therapeutic hypothermia led to faster cooling.
Assuntos
Regulação da Temperatura Corporal , Hospitais Comunitários , Hipotermia Induzida , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação das NecessidadesRESUMO
An estimated 700,000 cases of sepsis occur each year in the United States alone, over half of which will develop renal failure. Of those that develop renal failure, 70% will die. This article will examine how the use of vasopressin in sepsis may improve some aspects of renal function. The effects of vasopressin on the renal system in vasodilatory shock.