Critical Care Commons^™

An Evidence-Based Skin Management Improvement Project In The Intensive Care Unit, Chelsea Lannoo

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Improving Time To Defibrillation​, Jonathan Eyestone, Dana Gilbreth, Amanda Maloney, Tina Pham

Articles, Abstracts, and Reports

"ABSTRACT TITLE: Improving Time to Defibrillation

Background: Providence St. Vincent Medical Center (PSVMC) Medical Surgical units are not meeting the American Heart Association requirement of less than 3 minutes to defibrillation. Time to defibrillation in codes with shockable rhythms averages 4.2 minutes. In Mock Codes, only one met the time less than 3 minutes; four Mock Codes had times over 5 minutes. Resuscitation Quality Improvement CPR (RQI) training is required quarterly. Defibrillator practice with overall Code Blue competency is annual.

Purpose: Combine the hands-on practice of the defibrillator with the hands-on training for RQI.

Methods: The Medical Surgical unit 6 …

Whole Blood In Trauma, Jason P. Prevelige

Pacific Journal of Health

Abstract: Hemorrhage is a leading cause of death in trauma patients. Whole blood administration in trauma has gained a renewed interest in recent years, however the concept is not new at all, with its origins spanning over 100 years. Field experience in United States’ military conflicts has provided important data on the efficacy of whole blood in reducing mortality and amount of blood product administration. Civilian trials however have not necessarily shown similar results. The safety of whole blood however does not seem to be in question given the available data, and is an acceptable option for blood replacement in …

Issue 6: Pulmonary & Critical Care Insider, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 6

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Summaries/Topics in this issue:

Wasted Blood in Hospital Setting

Blood Transfusions

MINT Trial

Epinephrine related death

Non-invasive Airway Management of Comatose Poisoned Emergency Patients

Angiotensin II (AT2) and Vasopressors

Angiotensin II for the Treatment …

Improving Nutritional Delivery To Pediatric Patients On Continuous Renal Replacement Therapy, Jennifer Ruiz-Boada, Sarah Brunner, Tara Benton, Vimal Chadha

Presentations

INTRODUCTION: Continuous renal replacement therapy (CRRT) is used in critically ill children with acute renal failure. CRRT can lead to malnutrition by removing essential proteins and micronutrients. Malnutrition is associated with worse outcomes, including increased length of stay and mortality. CRRT guidelines suggest the importance of early nutrition and ensuring high protein intake. After evaluating our CRRT patients, we found sub-optimal adherence to the guidelines. This Quality Improvement project aimed to increase the percentage of patients achieving 75% of their goal protein and caloric intake by day 5 of CRRT initiation by 15% by August 2023. METHODS: A multidisciplinary group …

Lazarus Syndrome After Aortic Aneurysm Repair, Kevyn Niu, Jamie Lee Aldakkour, Charles Huyghues-Despointes, Yizhi Lin

HCA Healthcare Journal of Medicine

Introduction

Lazarus syndrome is defined as the spontaneous return of circulation after cessation of cardiopulmonary resuscitation (CPR). Though there have been multiple cases of Lazarus syndrome documented in the literature, it is a significantly underreported phenomenon with less than 100 cases reported in the literature since the first case in 1982.

Case Presentation

After elective aortic aneurysm repair, an 88-year-old with a do-not-resuscitate directive had cardiac arrest, briefly showing post-mortem respiration and pulse. Despite resuscitation efforts including pharmacological intervention and CPR, he passed away within an hour. This case highlights complexities in end-of-life care and warrants exploration of post-mortem physiological …

Beyond The Basics: Unraveling The Complexity Of Coronary Artery Calcification, Satwat Hashmi, Pashmina Wiqar Shah, Zouhair Aherrahrou, Elena Aikawa, Rédouane Aherrahrou

Department of Biological & Biomedical Sciences

Coronary artery calcification (CAC) is mainly associated with coronary atherosclerosis, which is an indicator of coronary artery disease (CAD). CAC refers to the accumulation of calcium phosphate deposits, classified as micro- or macrocalcifications, that lead to the hardening and narrowing of the coronary arteries. CAC is a strong predictor of future cardiovascular events, such as myocardial infarction and sudden death. Our narrative review focuses on the pathophysiology of CAC, exploring its link to plaque vulnerability, genetic factors, and how race and sex can affect the condition. We also examined the connection between the gut microbiome and CAC, and the impact …

Myocardial Protection In High-Risk Cardiopulmonary Bypass Support, Subhasis Chatterjee, Marc R. Moon

Journal of Shock and Hemodynamics

The development of cardioplegia has facilitated complex cardiac surgery and allowed high-risk patients to safely tolerate life-saving procedures. By following the principles of electromechanical arrest, inducing hypothermia, and using adjunctive agents to help mitigate the effects of hypothermia and ischemia reperfusion injury, cardioplegia can be safely induced with various commercially available compositions, which can be delivered by several different surgical techniques. Although many studies have compared these methods, there is little consensus on whether any one method is superior to another. Just as a surgeon may need to modify technique according to individual patient factors, so too must a surgeon …

Allergic Bronchopulmonary Aspergillosis: Radiological And Microbiological Profile Of Patients Presented In An Outpatient Pulmonary Clinic In A Developing Country, Nousheen Iqbal, Muhammad Irfan, Mustafa Bin Ali Zubairi, Maaha Ayub, Safia Awan, Kauser Jabeen, Ali Bin Sarwar Zubairi

Section of Pulmonary & Critical Care

There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 …

Massive Transfusion And Shock Index, Kasey House

MSN Capstone Projects

Hemorrhagic shock is one of the leading causes of preventable death in military trauma patients. Literature shows that pre-hospital transfusions of blood products within the combat environment have shown to have a greater likelihood of survival. This has produced a challenge in the pre-hospital setting to have a standardized method of predicting the patient’s need for a massive transfusion. In the last few years, the development of a Massive Transfusion Protocol (MTP) has become the standard to quickly deliver blood products to actively bleeding patients. Every minute waiting to administer blood products increases mortality by 5%.

While initiating an MTP …

Role Of Midodrine On Vasopressor Duration In Patients With Sepsis, Kamah J. Ellena, Jenna L. Combs, Heather M. Draper, Julie J. Belfer

Journal of Shock and Hemodynamics

Existing literature evaluating the off-label use of midodrine has focused primarily on postoperative hypotensive patients requiring a single vasopressor. This study aimed to evaluate the impact of midodrine on vasopressor duration and length of stay in patients receiving vasopressors for sepsis-related hypotension. This is an institutional review board-approved, single-center, retrospective analysis of critically ill patients with hypotension secondary to sepsis who received midodrine and intravenous vasopressors compared to those who received intravenous vasopressors alone. Patients were matched by Acute Physiology and Chronic Health Evaluation II score, suspected source of infection, and presence of bacteremia. One hundred patients were included in …

Pulmonary & Critical Care Insider: Issue 4, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 4

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Summaries/Topics in this issue:

• Inside Medicine- Ozempic

• Inhaled Amikacin for VAP (AMIKINHAL Trial)

• 2023 GOLD Guidelines for COPD

• SAGA of Antibiotics in the ICU

• The MANDALA trial

• The DENALI trial

• RESCUE IHCA – Not …

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Pulmonary & Critical Care Insider: Special Issue 5: 2023 In Review, Bharat Bajantri Md, Sarah Ellsworth-Hoffman Mls

Critical Care & Pulmonary

Pulmonary & Critical Care Insider Issue 5: Special Issue

Compiled by Bharat Bajantri, MD, and librarian Sarah Ellsworth, MLS for the clinicians of the Pulmonary and Critical Care team of Parkview.

The goal of this newsletter is to give a brief summary of the most pertinent articles to everyday practice and an attempt to keep up with literature as best as possible. Newsletters go out every 1-2 months.

Survey Of Pediatric Critical Care Fellows On Postresuscitation Debriefing, Nicole K. Sather, Lauren E. Zinns, Gillian Brennan, Lily Guo, Nadia Khan, Vinod Havalad

Journal of Patient-Centered Research and Reviews

Purpose: Current guidelines recommend debriefing following medical resuscitations to improve patient outcomes. The goal of this study was to describe national trends in postresuscitation debriefing practices among pediatric critical care medicine (PCCM) fellows to identify potential gaps in fellow education.

Methods: A 13-item survey was distributed to fellows in all 76 ACGME-accredited PCCM programs in the United States in the spring of 2021. The online survey addressed frequency and timing of debriefings following medical resuscitations, whether formal training is provided, which medical professionals are present, and providers’ comfort level leading a debriefing. Results were analyzed using descriptive statistics.

Results: A …

Pakistan Study Of Premature Coronary Atherosclerosis In Young Adults (Pak-Sehat): A Prospective Longitudinal Study Protocol Investigating The Prevalence, Severity And Determinants Of Atherosclerotic Cardiovascular Disease In The Young Adult Pakistani Population, Bashir Hanif, Sana Sheikh, Ghazal Peerwani, Miguel Cainzos-Achirica, Wajiha Javed, Jaffer Bin Baqar, Zainab Samad, Faiza Bashir, Salim S. Virani, Khurram Nasir

Section of Cardiology

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is a major cause of morbidity, mortality and health expenditures worldwide. Despite having higher ASCVD in the Pakistani population, data on subclinical coronary atherosclerosis in young Pakistanis remain scarce. The PAKistan Study of prEmature coronary atHerosclerosis in young AdulTs (PAK-SEHAT) aims to assess the prevalence, severity and determinants of subclinical coronary atherosclerosis among Pakistani men (35-60 years) and women (35-65 years) free of clinically symptomatic ASCVD and will assess 5-year rates of ASCVD events.
Methods and analysis: PAK-SEHAT is an ongoing prospective cohort study with 2000 participants from all provinces of Pakistan who will be …

Oral Sucrose And The Relation To Neonatal Pain Perception, Meagan L. Burns

MSN Capstone Projects

Pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage” (Treede, 2018). The phenomenon of pain is a personal and unique experience that many of the world’s population has experienced in some form or fashion throughout their lifetime. Neonates are exposed to many painful procedures and/or situations due to various medical ailments that may require a neonatal intensive care unit (NICU) admission. Infants have a special place in the hearts of adults all over the world, and any interventions that would increase the likelihood of diminishing or removing perceived pain in this population are likely …

Ten Steps Toward Improving In-Hospital Cardiac Arrest Quality Of Care And Outcomes, Brahmajee K. Nallamothu, Robert Greif, Theresa Anderson, Huba Atiq, Thomaz Bittencourt Couto, Julie Considine, Allan R De Caen, Therese Djärv, Ann Doll, Matthew J. Douma

Department of Anaesthesia

No abstract provided.

Methodological Analysis Of A Community-Based Training Initiative Using The Epis Framework: An Ongoing Initiative To Empower 10 Million Bystanders In Cpr And Bleeding Control, Asma Altaf Hussain Merchant, Sheza Hassan, Mirza Noor Ali Baig, Huba Atiq, Sana Mahmood, Adil H. Haider, Zia Ul Haq, Deeba Shehnaz, Rizwan Naseer, Junaid Razzak

Medical College Documents

Background: Out-of-hospital cardiac arrest (OHCA) and life-threatening bleeding from trauma are leading causes of preventable mortality globally. Early intervention from bystanders can play a pivotal role in increasing the survival rate of victims. While great efforts for bystander training have yielded positive results in high-income countries, the same has not been replicated in low and middle-income countries (LMICs) due to resources constraints. This article describes a replicable implementation model of a nationwide program, aimed at empowering 10 million bystanders with basic knowledge and skills of hands-only cardiopulmonary resuscitation (CPR) and bleeding control in a resource-limited setting.
Methods: Using the EPIS …

Psychological Safety And Conflict Management Among Nurse Practitioners In Interprofessional Teams, Scott Faust

Electronic Theses and Dissertations

This quantitative correlational study explored the relationships between perceived psychological safety, conflict management styles, and perceived conflict management success among nurse practitioners (NPs) operating in interprofessional acute or critical care teams in the United States. Despite existing literature on conflict management and psychological safety, there is a noticeable gap concerning the interplay of these factors, specifically among NPs. A multi-item survey was developed from validated measures to assess psychological safety, conflict management success, and conflict management style. The final sample included 944 NPs. The findings revealed a statistically significant difference in the scores of perceived psychological safety, depending on the …

Best Therapeutic Practices In The Management Of Obstetric Sepsis, Gabriel Petre Gorecki, Oana Denisa Balalau, Diana Elena Comandasu, Anca Daniela Stanescu, Dana Rodica Tomescu

Journal of Mind and Medical Sciences

Background. Physiological changes that occur during pregnancy make maternal sepsis a difficult condition to diagnose and treat, still having a fairly high mortality rate. Consequently, an early diagnosis and prompt therapeutic management of sepsis can significantly decrease mortality. The purpose of this study is to review literature data that present current practices in the management of obstetric sepsis. Methods. To collect the data required for the study, we performed a search of published articles in the PubMed and Google Scholar databases related to obstetric sepsis. Research paper articles from the period 2012-2022 were included in the analysis. In addition, 145 …