CPR: is it cruel or is it kind?

When people have a cardiac arrest, whether in hospital or the community, there is a presumption is that cardiopulmonary resuscitation should be attempted in all but exceptional circumstances. This is based on ethical, legal, political and cultural principles. However, few patients leave hospital with their faculties intact following CPR, which often simply postpones death for a short time. The authors argue that this represents a poor use of public resources and condemns many patients to severe debilitation. They suggest that the focus should move towards preventing cardiac arrest, so that scarce resources can be redirected to interventions with proven benefits.     

Calcium administration for cardiovascular support in critically ill patients: when is it indicated?

Calcium has a fundamental role in the maintenance of myocardial function and vascular tone. The ionized form of calcium is the most important physiologically, and this form needs to be measured to assess physiologically active calcium levels. Ionized hypocalcemia can occur as a result of various pathophysiological disturbances, and it is seen frequently in critically ill patients. Several investigators have observed a poorer prognosis in those patients with ionized hypocalcemia. It is unclear whether calcium supplementation is beneficial in these patients. It may improve cardiovascular performance, but, in contrast, it may contribute to cellular damage (especially during hypoxia following cardiopulmonary resuscitation). In sepsis, there may be an increased cellular influx of calcium, which may be deleterious to cellular function; indeed, calcium entry blockers in this situation may be protective. We review the role of calcium as an inotropic agent, its interaction with other inotropic agents, and its use during blood transfusion and during cardiopulmonary resuscitation.     

The sick building syndrome: what is it when it is?

Sick building syndrome is a commonly applied diagnosis; often abused and misinterpreted to denote headaches, dizziness, fatigue and eye irritation associated with a building The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article.     

Anemia: when is it iron deficiency?

Iron deficiency anemia, the most common of childhood anemias, presents many challenges to the practitioner. Careful history taking that includes nutritional assessment may uncover this frequently subtle condition. In keeping with AAP recommendations, screening will aid in diagnosing this condition in populations at risk. Prompt treatment and conscientious follow-up will afford the most optimal outcome.     

Infections in hospitalized patients: what is happening and who can help?

The continuing emergence of multidrug-resistant bacteria calls for new approaches to the management and treatment of infections in hospitalized patients. Health care-associated infections cause substantial morbidity and mortality while driving up health care resource use and costs worldwide. The continued spread of antimicrobial resistance requires a multidisciplinary approach and closer collaboration among health care providers, especially hospitalists, pharmacists, infection control practitioners, and infectious disease specialists. Such collaboration can potentially reduce treatment failures and minimize the spread of multidrug-resistant organisms between health care settings and the community.     

Anemia: when is it not iron deficiency?

Anemia presents a challenge both in determination of cause and appropriate management. Careful history taking and appropriate screening in keeping with AAP recommendations will aid in identifying cases of anemia. Judicious use of laboratory testing will assist in achieving accurate diagnosis. Finally, appropriately timed and monitored treatment strategies will offer the most optimal outcome.     

Spinal immobilization in trauma patients: is it really necessary?

The acute management of potential spinal injuries in trauma patients is undergoing radical reassessment. Until recently, it was mandatory that nearly all trauma patients be immobilized with a back board, hard cervical collar, head restraints, and body strapping until the spine could be cleared radiologically. This practice is still recommended by many references. It is now clear that this policy subjects most patients to expensive, painful, and potentially harmful treatment for little, if any, benefit. Low-risk patients can be safely cleared clinically, even by individuals who are not physicians. Patients at high risk for spinal instability should be removed from the hard surface to avoid tissue ischemia. Understanding the rationale for these changes requires knowledge of mechanisms of injury, physiology, and biomechanics as they apply to spinal injuries.     

CPR in terminally ill patients?

While limiting and foregoing therapy at the end of life is now accepted on medical, ethical, moral and legal grounds, many Americans continue to die with heroic measures being taken to prevent their death. When the patient does eventually die, attempts are frequently made to revive the patient by performing cardiopulmonary resuscitation (CPR). While CPR may result in the establishment of a perfusing pressure, in almost all instances, the patient succumbs despite advanced life support technology. The widespread adoption of do-not-resuscitate (DNR) protocols has not prevented CPR from being performed on patients, who are unlikely to survive. We present two cases, which highlight the modern American way of dying. We submit that poor end-of-life care may result from physicians discomfort with death, their poor communication skills and their failure to fully comprehend the benefits and limitations of advanced life support technology. Furthermore, we maintain that CPR should only be performed on patients, who are likely to derive benefit from this intervention.     

Critical thinking: what does it mean in the care of elderly hospitalized patients?

In today's complex healthcare environment, it is more important than ever that nurses possess critical thinking skills to provide optimal care for their patients. This article offers a definition of critical thinking for nurses and describes the importance of critical thinking in the care of our growing elderly patient population. Examples related to geriatric nursing care, including acute care, dementia care, and end-of-life care, are provided to reinforce the importance of critical thinking and its benefits to our elderly patient population.     

Nurses' perceptions: when is it a medication error?

This study investigates nurses' perceptions of medication errors and appropriate reporting. Results of the study suggest that nurses may not report because of fear of reprisal. Further, there may be a need to allow for nursing judgment in some instances; at those time, the term "medication error" may not be the most appropriate. Implications for nursing administration include further exploration of nonpunitive processes in response to adverse drug events.     

Endobronchial ultrasound: what is it and when should it be used?

Endobronchial ultrasound has become increasingly used in the UK as a lung cancer staging and diagnostic tool. It has many applications especially in the mediastinal lymph nodes but also the vascular structures as well as the airway wall itself. It is superior to conventional transbronchial needle aspiration in lung cancer staging and diagnosis of mediastinal lymphadenopathy. With time it may well replace mediastinoscopy completely for staging lung cancer. There are, however, training issues and revenue-based tariff systems have been slow to reflect this innovation. Future developments may include routine use in the assessment of central pulmonary vasculature and assessment of airway wall remodelling.     

Quality of life in cancer patients: whose business is it anyway?

Editorial

Quality of life in cancer patients: whose business is it anyway?     

Orem's self-care model: is it relevant to patients in intensive care?

Nursing care in the intensive therapy unit has tended to follow a medical model and has concentrated on the physical needs of the patient. With the emergence of nursing models intensive care nurses are beginning to question more than previously the care that they are giving. The use of a structured model gives direction to patient care and potentially benefits both the patient and the nurse. However it is necessary to examine closely the relevance of the model to the area of nursing, the needs of the individual patient and the philosophy held by the nurses in that area.Over recent years Orem's self-care model has become popular. This paper considers the major concepts of the model in relation to the intensive therapy unit and the possible benefits and difficulties of applying the model to this area. It is concluded that although the possibilities of achieving self-care for the critically ill patient are limited the use of the model encourages an individualised approach to care and heightens awareness of the patient as a whole.