Category: Critical Care Nursing Capnography provides dynamic monitoring of ventilatory status in patients with acute respiratory distress, such as from asthma, bronchiolitis, chronic obstructive pulmonary disease, congestive heart failure and cystic fibrosis.
Category: Critical Care Nursing In addition to uses in resuscitation, capnography can also be used to monitor patients with active seizures and maintain appropriate ETCO2 levels in patients with elevated intracranial pressure.
Category: Critical Care Nursing During cardiac arrest, ETCO2 reflects the degree of pulmonary blood flow as alveolar ventilation and basal metabolism are constant, so that it can be used to gauge effectiveness of cardiopulmonary resuscitation.
Category: Critical Care Nursing Capnography is used in the ED for intubated and nonintubated patients. For intubated patients, it provides information regarding respiratory function and ventilator settings and gives immediate notification of accidental extubation.
Category: Critical Care Nursing Pulse oximeters are generally accurate between 80% and 100% saturation, but large changes in the SpO2 can occur with small changes in the PaO2 in hypoxic patients. Below this range, the role is reversed.
Category: Critical Care Nursing Pulse oximetry measures the percentage of arterial hemoglobin that is in the oxyhemoglobin state. It reflects the amount of oxygen that hemoglobin is carrying as a percent of the maximum it can carry.
Category: Critical Care Nursing The gold standard and the most accurate method of measuring blood pressure, remains the intraarterial catheter. However, this method is invasive and time intensive, and carries the infrequent but real risk of arterial injury or thrombosis.
Category: Critical Care Nursing Blood pressure monitoring remains a standard and important ongoing measure of changes in the physiologic adaptation to stress and serves as a dynamic measure and singular predictor of adverse outcomes in medical and surgical patients.
Category: Critical Care Nursing The pulse pressure is important because it closely resembles stroke volume when accounting for arterial compliance and resistance. At a given arterial compliance (C), stroke volume (SV) is associated with changes in pulse pressure: C = SV/PP.
Category: Critical Care Nursing Flumazenil should be used with extreme caution in patients with benzodiazepine dependence or a history of seizures because it may precipitate life-threatening status epilepticus refractory to common treatment.
Category: Critical Care Nursing Flumazenil has a rapid onset of action in 1 to 2 minutes, peak effect in 5 to 10 minutes, and clinical duration of 30 to 90 minutes. Continuous patient monitoring must be ensured with longer lasting benzodiazepines because resedation is likely.
Category: Critical Care Nursing Flumazenil is a competitive antagonist of benzodiazepines. Although it reverses sedation, it is not as effective for reversing respiratory depression. In general, when oversedation occurs, brief support of ventilation permits the patient to recover.
Category: Critical Care Nursing Naloxone is a competitive antagonist of opioids and has been effectively used for the reversal of opioid-induced respiratory depression. It has a rapid onset of action and half-life of 45 minutes, although its effects last only 15 to 30 minutes.
Category: Critical Care Nursing Propofol is another ultra short-acting sedative-hypnotic that has no analgesic properties. It has an extremely rapid onset, short duration of action and predictable efficacy for inducing deep sedation.
Category: Critical Care Nursing Etomidate has been used for deep sedation because of its rapid onset, short duration of action and, most importantly, minimal effects on respiratory and cardiovascular function.