RESUMO
The success of each air medical transport mission is dependent on the coordinated efforts of communications specialists, aviation personnel, medical crew members, referring hospitals, local emergency medical services, and fire and law enforcement personnel. Expedited, efficient, and safe patient transport is made possible through the collaboration of all the aforementioned disciplines. In this specialized, unpredictable, and high-pressure environment, each entity plays its own crucial role in rapidly delivering critical care directly to the patient in need.
Assuntos
Serviços Médicos de Emergência , Humanos , Recursos HumanosRESUMO
Prehospital rapid sequence intubation (RSI), like inpatient RSI, is not without risk of adverse effects to the patient. The most notable of these adverse effects is postintubation hemodynamic instability. Air medical providers choose induction agents for critically ill patients who require emergent airway management, some of whom may already be hemodynamically unstable prior to RSI. Ketamine is often selected as the induction agent of choice for patients who are either unstable before RSI or have a high index of suspicion of becoming unstable in the postintubation period. Although widely considered to have a good safety profile for induction, ketamine administration has been correlated with episodes of postintubation hypotension. In this retrospective literature review, the effect of using half-dose ketamine for induction in patients who show pre-RSI instability (systolic blood pressure <90 mm Hg or body mass index >30) on postintubation hemodynamics is examined.
Assuntos
Ketamina , Humanos , Manuseio das Vias Aéreas , Intubação Intratraqueal/efeitos adversos , Ketamina/uso terapêutico , Indução e Intubação de Sequência Rápida , Estudos RetrospectivosRESUMO
Blended bedside report increases peer-to-peer accountability among nurses, improves communication between nurses as well as patients, and promotes patient safety. Despite the literature that documents bedside report is best, a practical guide to initiating this process in a hospital setting is lacking. A unit-based council composed of staff nurses and 1 member of nursing management on a neurosurgical intensive care unit designed a unit-wide education initiative involving multiple modalities and peer-to-peer training. This combination led to a successful culture change from traditional report to blended bedside reporting process.