No abstract

Background Continuous ischemia monitoring helps identify patients with acute, but often silent, myocardial ischemia. Evidence suggests nurses do not activate ischemia monitoring because they think it is difficult to use. ST-Map software incorporates graphic displays to make monitoring of ongoing ischemia easier. Objectives To determine if nurses’ use of and attitude toward ischemia monitoring and the quality of patient care improve with use of ST-Map. Methods The study included 61 nurses and 202 patients with acute coronary syndrome in a cardiac intensive care unit. Baseline data on nurses’ use of and attitude toward ischemia monitoring and quality of care were obtained. Education was then provided and ST-Map software was installed on all monitors. Follow-up data were obtained 4 months later. Results The percentage of nurses who had ever used ischemia monitoring was 13% before ST Map and 90% afterward (P < .001). The most common reason for not using ischemia monitoring before ST Map was inadequate knowledge (62%). The most common reason for liking ischemia monitoring after ST Map was knowing when a patient has ischemia (80%). Time to acquisition of a 12-lead electrocardiogram in response to symptoms or ST-segment changes was 5 to 15 minutes before ST Map and always less than 5 minutes afterward (P < .001). Time to return to the catheterization laboratory did not differ before and after ST Map. Conclusions ST Map was associated with more frequent use of ischemia monitoring, improved attitudes of nurses toward ischemia monitoring, and shorter time to obtaining 12-lead electrocardiograms.

Both pharmacological and nonpharmacological methods are used to control shivering in therapeutic hypothermia. An evidence-based protocol based on the most current research has been developed for the management of shivering during therapeutic hypothermia. Meperidine is the drug of choice and provides the greatest reduction in the shivering threshold. Other effective pharmacological agents recommended for reducing the threshold include dexmedetomidine, midazolam, fentanyl, and magnesium sulfate. In addition, skin counterwarming techniques, such as use of an air-circulating blanket, are effective nonpharmacological methods for reducing shivering when used in conjunction with medication. As a last resort, neuromuscular blocking agents are considered appropriate therapy for management of refractory shivering.

Mechanical ventilation is a life-sustaining technology used with increasing frequency in the elderly population. Prolonged mechanical ventilation is associated with high morbidity, mortality, and poor functional status. Care of these complex patients requires a coordinated multidisciplinary approach to optimize outcome. To minimize mortality and morbidity and contain health care costs, it is essential to identify patients at high risk for prolonged ventilation and to implement early interventions to curtail functional decline. In this article, the incidence and outcome of prolonged mechanical ventilation is reviewed, along with interventions to promote recovery. In particular, the role of tracheostomy timing and placement is discussed.