Critical Care Commons^™

Acute Care Staff Interactions With Chaplains To Discuss Personal, Non-Work-Related Stressors, Gary Weisbrich, Teresa Rangel

Central Division Nurse Clinical Inquiry Conference

No abstract provided.

Moral Injury, Moral Resilience, And The Healthy Work Environment Among Icu Nurses: A Secondary Analysis, Angie Shemwell, Sarah Sumner

Central Division Nurse Clinical Inquiry Conference

No abstract provided.

A Team Mentor Project To Reduce Turnover On A Cicu, Sarah Evans

Central Division Nurse Clinical Inquiry Conference

Abstract:

Background

From 2022-2023, a 28-bed cardiac care intensive unit (CICU) employing 120 Registered Nurses (RNs) hired 63 RNs, including 3 new graduates and 32 new-to-specialty, following significant turnover. Nurses in the CICU frequently face complex situations, leading to emotional distress and potential turnover if coping resources are not provided. Research suggests that pairing a new CICU nurse with an experienced mentor to help cope with complex situations can significantly increase confidence and resiliency and reduce emotional distress and turnover. On our CICU, nurses are assigned a preceptor for 12-20 weeks to orient to CICU-specific competencies without an emphasis on …

A Rare Case Of Takotsubo Cardiomyopathy In An Elderly Lady During Hospital Stay, Himabindu Kolli, Ashika A. Chacko, Pooja Maknoor, Nazish Khan, Timothy Heath

Research Colloquium

Introduction: Takotsubo Cardiomyopathy (TTC) is an acute, reversible form of left ventricular systolic dysfunction, most often triggered by a sudden physical, or less commonly emotional event. Here, we describe a patient who developed Takotsubo Cardiomyopathy during her hospital stay.

Case Description: 74-year-old Hispanic lady, a nursing home resident presented to the ED with altered mental status. She was admitted for septic shock due to UTI. Echocardiogram demonstrated normal systolic function, with 60-65% LV ejection fraction. After initiation of antibiotic therapy, she showed clinical improvement with resolution of shock.

On day 8 of hospitalization, patient became emotionally upset and her clinical …

Multisystem Inflammatory Syndrome In Children (Mis-C): Is There A Relationship To Typhus?, Juliana Hager, Juliana Hager, Jacob Smith

Research Colloquium

The United Kingdom first reported in April 2020 a group of eight previously healthy children with a link to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that presented with systemic inflammation and multi-organ involvement, now named multisystem inflammatory syndrome in children (MIS-C). The Centers of Disease Control and Prevention (CDC) have reported over 1000 cases since the primary discovery as of October 2020 with 20 total deaths. [1] The clinical features of MIS-C have been previously compared to inflammatory syndromes including Kawasaki disease (KD) and toxic shock syndrome (TSS). We describe the clinical presentation and management for 3 pediatric cases with …

Covid-19 As A Second Hit For Anti-Phospholipid Syndrome, Himabindu Kolli, Pooja Maknoor, Celin Rajan, Nevin Varghese

Research Colloquium

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by venous and arterial thrombosis, usually in setting of underlying autoimmune disorders. Here, we present a case of anti-phospholipid syndrome post covid infection.

Case Presentation: 41-year-old lady presented to the ER with complaints of left sided facial droop for 3-day duration. On further evaluation, she was found to have subacute ischemic stroke and was managed with anticoagulation and supportive treatment. Past medical history is significant for a recent diagnosis of Covid infection and for subsequent development of lower extremity deep vein thrombosis (DVT). She was started on anticoagulation with rivaroxaban for …

Cardiac Tamponade: Innovative Sternotomy Simulation Model For Training Pediatric Cardiac Intensive Care Team, Tolu Akinpelu, Mohammed Alhendy, Malarvizhi Thangavelu, Karen Weaver, Nicole Muller, James Mcelroy, Daniel Nento, Utpal Bhalala

Research Symposium

Introduction: Cardiac tamponade occurring after cardiac surgery is rare but life threatening and requires simultaneous resuscitation and emergent sternotomy by the intensive care team. A simulated scenario using innovative mannequin with sternotomy wound has the capability of reproducing cardiac arrest associated with postoperative tamponade. We evaluated the face validity of this innovative mannequin, the confidence level and crisis resource management skills of the team during sternotomy to manage postoperative cardiac tamponade.

Methods: The simulation case scenario was developed using innovative sternotomy mannequin for children’s hospital cardiac intensive care unit (CICU) teams. The case involved a 3-year old male, intubated, mechanically …

Cytokine Profile In A Pediatric Patient On Extracorporeal Membrane Oxygenation, Ashitha Rajeurs Do, Swosti Joshi Md, Jillian Deacon Rn, Dominick Carella Rn, Vilmaris Quinones Cardona Md, Ogechukwu Menkiti Md

St. Chris Research Day

No abstract provided.

Effects Of Just In Time Simulations On Resident Comfort And Performance During Mock Codes, James Alsop, Ashitha Rajeurs, Catherine Cheng, Swetha Madhavarapu

St. Chris Research Day

No abstract provided.

Therapeutic Plasma Exchange To Alleviate Ventricular Tachycardia After Diphenhydramine Ingestion, Kaushal Dosani, Lejla Music Aplenc, Stephen Pfeiffer

Research Days

Background: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support

Objectives/Goal: To describe a novel method of clearing highly protein-bound diphenhydramine molecules from circulation after …

A Comparison Of Large Tbsa Scald Versus Flame Burns In Young Children, Ashley Daniel

Research Days

Background: It is generally accepted that of children with the same total body surface area of burns, those with flame burns seem to have longer lengths of stay and more complications than those with scald burns. Anecdotally we have seen the opposite to be true. Among a consortium of five US pediatric burn centers participating in the Pediatric Injury Quality Improvement Collaborative (PIQIC), young children with scald burns seem to experience disproportionately more frequent and severe complications compared to their older counterparts and compared to patients of a similar age with flame burns.

Objectives/Goal: In this multi-institutional study, we compared …

Characterization Of Antibiotic Susceptibility Profiles Of Extensively- And Pan-Drug Resistant Acinetobacter Baumannii Clinical Isolates, Rachel Carr, Justin Halim, Rebecca Fliorent, Henry Fraimow, Dejan Nikolic, Valerie Carabetta

Rowan-Virtua Research Day

Acinetobacter baumannii is an opportunistic pathogen common in intensive care units (ICUs), particularly among immunocompromised individuals. Nosocomial A. baumannii infections have become increasingly problematic in recent years, as these bacteria rapidly acquire antibiotic resistance, leading to the emergence of multidrug, extensively drug and pan drug-resistant (MDR, XDR, and PDR, respectively) isolates. Recently, Cooper University Hospital (CUH) experienced a large increase in highly drug-resistant A. baumannii infections, which had a mortality rate of 60%. Oftentimes, physicians had to turn to combinations of drugs with no experimental verification or historically shelved antibiotics, such as the polymyxins, in a desperate attempt to save …

Brief Review: Iv Fluid Choice In The Emergency Department, Kaywan Saed, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Normal saline and balanced crystalloids, such as lactated Ringer's (LR) and Plasma-Lyte A, are commonly used in the emergency setting for fluid resuscitation. However, there has been growing interest in recent years in whether balanced crystalloids may be superior to normal saline, particularly in critically ill patients.

Normal saline has been the traditional fluid of choice for decades due to its widespread availability, low cost, and presumed safety. However, normal saline has a high chloride concentration (154 mmol/L), which can lead to hyperchloremic metabolic acidosis and other adverse effects, such as renal vasoconstriction and reduced renal blood flow.

In contrast, …

Isolated Temazepam Overdose: A Unique Case Of An Unresponsive Female, Eric Doane

Rowan-Virtua Research Day

Cases of acute overdose presenting to the emergency department pose a great challenge given that history can sometimes be limited or at times be inaccurate. While naloxone is routinely given in the field to help reduce opiate’s sedating effects, the routine use of flumazenil has not been routinely adopted in cases of benzodiazepine overdose. This is because, unlike naloxone, there are many medications that act on the GABA receptor, and flumazenil is only specific for binding to the benzodiazepine/GABA receptor. This can lead to an unmasking of other medications that may be co-ingested that also effect the GABA receptor leading …

Sigmoid Perforation Extending Into The Abdominal Wall, Zamran Masih, Wayne Tamaska, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Sigmoid colon perforation and spread into the abdominal wall is a rare condition that can occur due to various causes such as diverticulitis, trauma, malignancy, or iatrogenic injury during surgery. Although rare, sigmoid colon perforation into the abdominal wall can result in significant morbidity and mortality if not promptly diagnosed and treated. Most common cause of diverticular disease leading to perforation is diverticulitis, accounting for 60% of all colonic perforations.

Up-02 Pharmacological And Non-Pharmacological Interventions For The Treatment Of Neonatal Abstinence Syndrome, Taylor Meetze, Reagan Bradley, Peyton Smith, Emily Sisk, Ryan Crawford

SC Upstate Research Symposium

Background: Newborns diagnosed with Neonatal Abstinence Syndrome (NAS) often experience extreme symptoms as their body’s withdrawals from substances. Pharmacological and non-pharmacological interventions are provided that aim to treat NAS. However, nurses should be aware of what treatment leads to better outcomes and shorter hospitalization.

Aim: The aim of the project was to compare the length of hospitalization of pharmacological and non-pharmacological interventions for newborns with mild NAS.

Methods: The team of researchers devised a research question to guide a search in the Cumulative Index of Nursing and Allied Health Literature (CINAHL) to identify relevant literature focused on pharmacological …

Development Of A Rn Clinical Coach Program To Improve Retention Of Icu Residents And Fellows, Megan Jones, Sarah Sumner, Kristen Mayberry

Providence Nursing Research Conference 2023 – Present

Development of a RN Clinical Coach program to improve retention of ICU residents and fellows

Background:
The COVID-19 pandemic caused contributed to significant increases in ICU nurse turnover. To restore the ICU nursing workforce and rebuild a healthy work environment, evidence-based strategies are needed to provide social support and ongoing clinical skills development for large cohorts of ICU residents and fellows.

Purpose:
The purpose of the Clinical Coach program was to increase retention of ICU residents and fellows and foster a healthy work environment at a ministry in Southern California.

Methods:
In September 2021 the ICU manager at Providence Saint …

Comprehensive And Multidisciplinary Approach To Icu Liberation, Frederliza (Deng) M. Flores, Jason Kurian

Providence Nursing Research Conference 2023 – Present

No abstract provided.