Patients In Critical Situations Research Articles

CUIDADOS DE ENFERMAGEM EM SITUAÇÕES TRAUMÁTICAS

In Brazil, nursing care in traumatic situations was based on the North American models adopted by the Fire Departments and the Mobile Emergency Care Service (SAMU). Due to issues related to legal aspects, in our country, one of the greatest challenges encountered in emergency care units, and one of the reasons that contributed to the support of several structures. METHODOLOGY: This is a descriptive epidemiological narrative review with a qualitative approach. It is a narrative review of the literature, a method that consists of a syntactic analysis of publications, enabling a synthesis of published studies and eliminating gaps that need to be filled by knowledge, through new bibliographic research. RESULTS AND DISCUSSIONS: Nursing professionals, equipped with solid scientific knowledge, play a crucial role in improving the quality of health services, especially in the care of patients in critical situations. This expertise contributes significantly to a better prognosis for patients, demonstrating that evidence-based practice is essential for positive results. CONCLUSION: With the development of this work, it was possible to evaluate the evidence found from literature on nursing care in traumatic situations and their complications. In addition, during this study, we saw the awareness of the nursing team about the importance of medical record notes, which, when well prepared, present valuable elements for the diagnosis of the patient’s needs and for the planning and evaluation of the assistance provided within the scope of nursing care.

Posttraumatic stress disorder and psychosocial risk factors in first response workers to emergencies mixed method

First responders to emergencies are exposed to various risks, including psychosocial risk factors. Caring for patients in critical situations, experiencing traumatic events, and working under highly complex conditions increase their probability of developing mental disorders, such as posttraumatic stress disorder (PTSD). The objective of the study was to determine the relationship between PTSD and psychosocial risk factors and to understand the experiences of the disorder in this population. An explanatory sequential mixed method research design was used. The quantitative phase was an analytical cross-sectional observational study (n = 193), and the qualitative phase was phenomenological (n = 5). The psychosocial risk factors that best explained the presence of PTSD symptoms were the influence of non-work conditions on work, religion, emotional avoidance, and professional support as individual factors related to coping strategies. Individual factors such as coping strategies were determining factors that explained the symptoms of PTSD, and the influence of non-work conditions on work. It was identified that the demands of the job and the organizational factors, such as leadership style and lack of institutional support, generate anguish in workers and affect their ability to regulate their emotions when exposed to critical incidents.

Villalobos Technique of vascular ligation and uterine compression for the Management of Obstetric Hemorrhage

The Villalobos Technique of vascular ligation and uterine compression is an innovative surgical approach designed for the effective management of obstetric bleeding, particularly in cases of uterine atony and during transcesarean procedures. This technique combines ligation of the uterine arteries with a compressive suture, allowing rapid control of bleeding while preserving the function of the uterus and, therefore, the patient's fertility. The procedure is fast and safe, providing an effective alternative to hysterectomy in situations where conservative management of the uterus is required. Furthermore, its simplicity makes it applicable in resource-limited settings where access to advanced technology is scarce, making it a valuable tool for reducing maternal mortality in emergency obstetric settings. Through a series of clinical cases, the technique has demonstrated its ability to effectively stop obstetric hemorrhage and stabilize patients in critical situations. Its implementation can have a significant impact on reducing mortality and improving clinical outcomes, especially in second and third level hospitals.

Pediatric nurses' grit and nursing intention during the COVID-19 pandemic: Mediating and moderating effects of mindset and psychological collectivism.

PurposeThis study aimed to identify the mediating and moderating effects of mindset and psychological collectivism, respectively, on the relationship between grit and nursing intention for children with emerging infectious diseases, including coronavirus disease 2019 (COVID-19), among pediatric nurses.MethodsWe conducted a crosssectional descriptive study with 230 pediatric nurses.ResultsGrit directly impacted mindset (β=.27, p<.001) and nursing intention (β=.20, p=.001). The direct effect of mindset on nursing intension (β=.28, p<.001) and the indirect effect of grit on nursing intension via mindset (β=.08, p<.001) were significant. Accordingly, mindset mediated the effect of grit on nursing intention. The effects of grit and psychological collectivism (β=.19, p=.003), respectively, on nursing intention were significant. However, the interaction between grit and psychological collectivism was not significant. Thus, psychological collectivism did not moderate the effect of grit on nursing intention.ConclusionThe findings demonstrate the importance of pediatric nurses' grit and mindset on their intended care for patients in critical situations. Cultivating a gritty culture and developing interventions to enhance nurses' personality traits associated with their performance will be crucial, and such measures are especially salient for pediatric nurses to face the new adjustments required in the era of COVID-19.

Conceptual Models of Nursing in Critical Care.

Introduction Intensive care units are systems organized for the provision of care to patients in critical situations. In general, it is suggested that intensive care consists of a multidisciplinary and interprofessional specialty. Nevertheless, the predominance, relative to the professions that incorporate these units, falls on nurses. A conceptual model of nursing provides a framework for reflection, observation, and interpretation of phenomena and, specifically, it provides guidelines and guidance for aspects of clinical practice. Objective To understand the applicability of conceptual models of nursing in intensive care units. Method Review of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The research was performed in CINAHL, Cochrane, Pubmed, Scopus, and Web of Science to identify studies published prior to 2021. Fourteen studies were selected. Results There is no conceptual model of nursing universally accepted as ideal for intensive care units. However, there is unanimity in the identification of several benefits associated with the application of a conceptual model of nursing in the care of critically ill patients. Conclusion For the selection of a conceptual model of nursing for these contexts, the focus should be on the person and the choice should fall on the model that is most appropriate to the patient, and not on the philosophy that supports the model. Considering the nature of care, the nursing team can select a model or a combination of models.

Multimodal Biosignal Acquisition System for Remote Health Monitoring

The aim was to summarize the research on remote health monitoring system that comprises of the multimodal biosignal acquisition system, thereby delivering multi-label classification and clinical decision support system (CDSS). Numerous studies were involved effectively which offers the rapid diagnosis for the patients in critical situations. The learning model was established using the multi-label classification, extending to decision support system which can be enriched using the context-awareness mechanisms to foresee the future vital signs, and thus delivering an alert to the patients or doctors to take up the required actions.

Unmanipulated haploidentical haematopoietic stem cell transplantation for children with severe aplastic anaemia.

Haploidentical haematopoietic stem cell transplantation (haplo-HSCT) used to be a third-line treatment option for childhood severe aplastic anaemia (SAA). We conducted this retrospective study of 36 children (38 transplants) who received haplo-HSCT from human leucocyte antigen (HLA)-mismatched related donors between July 2002 and November 2013 at five HSCT centres in China, including 17 cases that were 5/6 HLA matched (Group 1) and 21 that were 4/6 or 3/6 HLA matched (Group 2). Although patients in Group 2 had a higher incidence of grade II-IV acute graft-versus-host disease (57·9% vs. 5·9%, P=0·001), they had similar rates of graft failure (5·3% vs. 5·9%, P=0·742) and overall survival (80·8% vs. 93·8%, P=0·234) as Group 1. Unmanipulated haplo-HSCT is an effective treatment for SAA children with satisfactory outcome of this cohort, especially in the 5/6 HLA-matched group. For patients in critical situations, such as unresponsive to immunosuppressive therapy, refractory infection and failing first HSCT, to bring forward the timing of haplo-HSCT is a feasible salvage strategy with better and faster donor accessibility.

Respiratory complications after oesophagectomy for cancer do not affect disease-free survival

Recent studies have suggested that postoperative complications could have a potential negative effect on long-term outcome after oesophagectomy for cancer. Because respiratory failures represent the most frequent postoperative complication, we have investigated the prognostic impact of these complications on disease-free survival (DFS). From a prospective single-institution database of 405 consecutive patients who underwent transthoracic oesophagectomy for cancer, we retrospectively analysed medical charts of all patients with microscopically complete resection (R0, n = 384 patients). Complications were graded according to the modified Clavien classification. Respiratory complications were defined as atelectasis, pneumonia or acute respiratory distress syndrome in the absence of early surgical complications. Patients with grade 5 (postoperative mortality, n = 43, 11%) were excluded from the analysis. The remaining 341 patients were analysed for estimation of DFS according to the Kaplan-Meier method. Logistic regression analysis was conducted to discriminate predictive factors affecting DFS. According to the modified Clavien classification, postoperative complications rates were grade 0: 147 (44%), grade 1: 7 (2%), grade 2: 56 (16%), grade 3: 69 (20%) and grade 4: 62 (18%). Five-year DFS rates were not significantly different between grade 0 (no complication, 38%, n = 147) and other grades (grade 1, 2, 3 and 4 (64, 45, 56 and 48%, respectively)). Respiratory complications occurred in 107 patients (31%) and the 5-year DFS in this subgroup was 47% compared with 38% observed in grade 0 patients (P = 0.75). Clavien classification and respiratory complications did not come out in the univariate analysis of factors affecting DFS. On logistic regression, only two variables affected DFS: c-N stage and extracapular lymph node involvement. When postoperative mortality is excluded, postoperative complications do not affect DFS in patients with complete resection. This deserves substantial information regarding the prognosis of subgroup of patients in critical situations where incrementing intensive care is debated.

Emergency intraosseous access in a helicopter emergency medical service: a retrospective study

BackgroundIntraosseous access (IO) is a method for providing vascular access in out-of-hospital resuscitation of critically ill and injured patients when traditional intravenous access is difficult or impossible. Different intraosseous techniques have been used by our Helicopter Emergency Medical Services (HEMS) since 2003. Few articles document IO use by HEMS physicians. The aim of this study was to evaluate the use of intraosseous access in pre-hospital emergency situations handled by our HEMS.MethodsWe reviewed all medical records from the period May 2003 to April 2010, and compared three different techniques: Bone Injection Gun (B.I.G® - Waismed), manual bone marrow aspiration needle (Inter V - Medical Device Technologies) and EZ-IO® (Vidacare), used on both adults and paediatric patients.ResultsDuring this seven-year period, 78 insertion attempts were made on 70 patients. Overall success rates were 50% using the manual needle, 55% using the Bone Injection Gun, and 96% using the EZ-IO®. Rates of success on first attempt were significantly higher using the EZ-IO® compared to the manual needle/Bone Injection Gun (p < 0.01/p < 0.001). Fifteen failures were due to insertion-related problems (19.2%), with four technical problems (5.1%) and three extravasations (3.8%) being the most frequent causes. Intraosseous access was primarily used in connection with 53 patients in cardiac arrest (75.7%), including traumatic arrest, drowning and SIDS. Other diagnoses were seven patients with multi-trauma (10.0%), five with seizures/epilepsy (7.1%), three with respiratory failure (4.3%) and two others (2.9%). Nearly one third of all insertions (n = 22) were made in patients younger than two years. No cases of osteomyelitis or other serious complications were documented on the follow-up.ConclusionsNewer intraosseous techniques may enable faster and more reliable vascular access, and this can lower the threshold for intraosseous access on both adult and paediatric patients in critical situations. We believe that all emergency services that handle critically ill or injured paediatric and adult patients should be familiar with intraosseous techniques.

Granulocyte transfusions in neutropenic patients: beneficial effects proven?

Despite the huge armamentarium of modern antibiotics and anti-fungals, infections remain life-threatening events in patients with profound neutropenia. For decades, the value of granulocyte transfusions (GT) has been explored and results are still not conclusive. However, it has been shown that GT increase peripheral blood neutrophil counts of recipients and lead to migration of functional neutrophils into inflamed tissues. A favourable increment of absolute neutrophil counts is observed after concentrates from technically up-to-date apherese from granulocyte-colony stimulating factor-stimulated donors. Most studies indicated a potential positive effect on infection elimination with a minimum cell content of GT (1.5-3 x 10(8)/kg recipient body weight). Although to date the beneficial effect of GT is not proven in prospective randomized trials, in specific situations GT is an option to treat infections along with antibiotics when there is profound neutropenia. However, these patients in critical situations need to be treated within carefully designed studies based on the best known methods for providing granulocyte concentrates in sufficient dose and frequency, standardized similar to other blood product transfusions. That includes definition of minimum cell content, maximum interval between apheresis and application, storage conditions, methods of donor stimulation according to patient's body weight and frequency of GT. This review considers the results of recent studies using GT from cytokine-stimulated donors and the consequences and effects in recipients and donors.

Pervasive assistance system for mobile physicians on the road

Physicians have to react swiftly to save their patients' lives, especially if called to treat them far from medical structures, such as hospitals, clinics, emergency departments, etc. This is ensured by, among other things, determining as quickly as possible the healthcare institutions that have the necessary resources for medical intervention in critical situations. The goal of this paper is to propose a pervasive assistance system for mobile physicians that can localise, browse and reserve medical resources while in motion. The localisation subsystem is ensured by a new route-calculator algorithm based on Delaunay Triangulation (DT). We show that our approach, applied on road networks, is able to establish the Continuous k-Nearest Neighbours (CkNNs) while taking into account the dynamic changes of locations from which queries are issued. This approach can be exploited by physicians for medical resource localisation, browsing and reservation, considerably improving the services provided for patients in critical situations.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterElaine Boyd R.N., M.A.Elaine Boyd R.N., M.A.Search for more papers by this authorPublished Online:1 Dec 2006https://doi.org/10.1176/ps.2006.57.12.1811AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Appropriate Use of Police Officers?To the Editor: A column in the November issue ( 1 ) and a research report in the February issue ( 2 ) describe crisis intervention training (CIT) for police officers in Ohio. These reports are important because they offer a possible solution to the dilemma of sending police officers to interact with mental health patients in critical situations. As a psychiatric nurse and the wife of a police lieutenant, I appreciate the authors' attempt to address this problem. Their emphasis on encouraging partnerships between law enforcement and mental health providers is a progressive approach. The Ohio CIT program trains officers to recognize persons who are experiencing acute symptoms of mental illness and provides them with deescalation tools. Officers are also informed about available community resources. The authors describe an alternative paradigm that would benefit the health care and law enforcement communities and, more importantly, place responsibility for the care of these patients in more appropriate hands. A crisis intervention model could be developed in which dispatchers are trained to identify mental disturbance calls and dispatch emergency medical technicians and paramedics.A primary concern, however, involves training police officers to handle mental health crises. Police officers are not health care providers. A 40-hour course will provide much-needed information but should not be viewed as a solution to the emergency needs of mental health clients. The study in the February issue demonstrated an increase in the number of dispatch calls "related to mental disturbances" after the training. Heightened awareness of mental health issues among dispatchers as a result of the CIT training is the likely explanation. However, the dispatchers were given no additional training about how to triage these individuals appropriately. Dispatchers need to be trained to evaluate the situation by asking the correct questions and reporting the right information to the most appropriate emergency medical technicians and paramedics.Law enforcement officers are being assigned greater responsibility in our communities. In addition to providing for the safety of citizens and property, many are required to participate in activities such as Drug Abuse Resistance Education, community policing, Neighborhood Watch, bioterrorism preparation, and public education. Is it the best use of training dollars to prepare law enforcement officers to become experts in dealing with health care conditions? Paramedics have the background to deal with acutely ill patients. The Emergency Medical Technician Paramedic: National Standard Curriculum ( 3 ), a course for paramedics offered by the National Highway Transportation Safety Administration, covers topics such as communication, clinical decision making, and management of the combative mental health client, which provide a foundation for handling mental disturbance calls. Educational standards for police officers differ between states. However, a review of training options for police officers, including degree programs at Missouri Southern State University and training offered by California Peace Officer Standards and Training ( 4 ) and the New York Police Department ( 5 ), reveals that most offer little or no education about persons with mental illness. Dispatching police officers to determine whether patients require emergency treatment, placement, or arrest further criminalizes and demoralizes persons with mental illness. Emergency medical service personnel are the appropriate resource for crisis intervention for the mental health client. Ms. Boyd is a psychiatric nurse at Crittenton Children's Center, Kansas City, Missouri.

Pulse‐spray thrombolysis in acutely obstructed coronary artery in critical situations

Pulse-spray thrombolysis (PST) was performed to treat large coronary thrombus in 3 patients in critical situations. The originally developed pump system and a custom infusion catheter (SciMed/Boston Scientific, Maple Grove, MN) were used in combination. Case 1, a 48-yr-old male with extensive anterior myocardial infarction, failed to be recanalized by systemic thrombolysis. He underwent emergent coronary angiography, which revealed proximal occlusion of a large left anterior descending artery (LAD). TIMI 3 flow was achieved after 20 min with 200,000 units of urokinese by PST, followed by balloon angioplasty. In case 2, a 57-yr-old male, subacute stent thrombosis occurred 4 days after two and a half Palmatz-Schatz stents were implanted in mid-LAD. TIMI 3 flow was recovered at 20 min with 240,000 units of urokinese and an additional 72,000 units of rt-PA, followed by redilatation with a quarter-size larger balloon than that used in stent deployment. In case 3, a 70-yr-old male, during ultrasound study for unstable angina, a massive thrombotic complication occurred which occluded the left main trunk. PST was immediately performed under cardiac resuscitation, and the patient recovered from shock after 15 min. TIMI 3 flow was restored after 25 min. Two Palmatz-Schatz stents were implanted after thrombus completely disappeared. There were no complications, including distal embolization, intimal dissection, or bleeding. There was also no recurrence of the ischemic event. PST may be considered a potential treatment modality for coronary artery disease where large thrombus plays a major role. Cathet Cardiovasc Diagn 40: 101–108, 1997. © 1997 Wiley-Liss, Inc.

Health Care Providers' and Cancer Patients' Preferences Regarding Disclosure of Information About Advance Directives

The Patient Self-Determination Act (PSDA) of 1990 requires hospitals to tell patients when they are admitted to the hospital about their right to complete an advance directive. The purpose of the study was to learn how providers and patients believe information about advance directive should be presented. When focus groups of providers and patients from a regional cancer center were held, nurses expressed more comfort with the requirements of the PSDA than did physicians, who were particularly concerned about the effect of the Act on their ability to treat patients in critical situations. Although patients were in favor of advance directives, they felt that hospital admission was not the best time to learn about them. This exploratory study suggests that testing the effectiveness of distributing written information to patients before admission and using specially trained personnel to discuss advance directives with patients may be worthwhile.