Digital and lower extremity skin changes often signify critical underlying disorders. Patients in the intensive care unit also frequently have hemodynamic instability requiring the use of vasoactive medications, which may lead to various presentations of limb ischemia; preexisting conditions increase these patients’ risk for arterial embolization. Most arterial emboli are clots that originate in the heart and travel to distant vascular beds, where they cause arterial occlusion, ischemia, and, potentially, infarction; the 2 most common sequelae are stroke and lower limb ischemia. Emboli also arise from atherosclerotic plaques. Other conditions can also cause skin color changes in this vulnerable population. Prompt recognition and differentiation of lower extremity skin changes can result in improved patient outcomes. A thorough literature search was conducted to differentiate the primary causes of lower extremity and digital skin changes in the critically ill patient and outline diagnostic and management techniques.
Many child care directors inherit their role of supervisor without having had adequate training or experience. Given the wide disparity in the field with respect to staff preparation, child care directors, in their role as supervisors, are called on to develop, train, evaluate, and appraise child care workers on a daily basis. The literature in the field suggests that there are common threads among supervisory models in early childhood and that directors of child care programs can benefit from in-service training that specifically addresses their supervisory functions.
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