58 results on '"Richard Arbour"'
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2. 720 Transcultural Collaboration in Burn Mass Casualty Response Under Austere Conditions
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Richard Arbour
- Subjects
Rehabilitation ,Emergency Medicine ,Surgery - Abstract
Introduction Burn mass-casualty incidents (BMCI) overwhelm local resources challenging communication, triage, basic care provision and education of non-burn specialist personnel. This is more acute in austere conditions such as the recent international BMCI in November, 2021, in an extremely resource-limited developing country. Greater than 250 severely burned survivors overwhelmed local resources requiring an international response. Effective burn care dictated adapting to austere conditions, educating local providers and cultural competence, vital to teaching and obtaining feedback in ways meaningful to host providers and building burn care capacity. Methods Needs assessment showed local healthcare providers needed burn care education focused on wound care, fluid management, pain management and assessment. Cultural competence/cultural humility were integral in avoiding ethnocentrism and collaboration barriers. Understanding local language and communication styles (including nonverbal cues) was prioritized. Pre-test/post-test measured baseline burn care knowledge vs. education efficacy. Lecture/discussion, case study, clinical application and class participation were used to disseminate content. Attention was paid to pace of content discussion and nonverbal indications of understanding as English was not the learners first language. Pacing/terminology was adjusted to optimize understanding. Meaningful recognition was accomplished by public congratulations and formal completion certificates. Results Pre-test: Number of students-57; high score-80%; low score-27.5%; average score-53.9%. Content was presented as described in methods section and supplemented with bedside instruction. Post-test: Number of students-38; high score-95%; low score-55%; average score-79.3%. Almost immediately, many participants framed and posted their completion certificates and quickly utilized education content when delivering care. Conclusions Optimal interdisciplinary/international collaboration for burn care and education in austere conditions mandates cultural humility and a spirit of inquiry on the part of international guest providers to best understand cultural norms in host countries. A spirit of inquiry on local communication and cultural nuances is integral to optimal collaboration, education and building effective local burn care capacity. Applicability of Research to Practice When providing care internationally in austere settings, proactive cultural humility, understanding local cultural and communications nuances and developing education/content delivery that can be readily utilized in addressing critical needs is essential. Meaningful recognition for healthcare team members in host countries develops good will and helps build capacity to continue providing health care upon conclusion of the immediate crisis.
- Published
- 2023
3. 281: BURN TRAUMA, INHALATION INJURY, ECMO SUPPORT, AND DEFINING FUTILITY
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Richard Arbour and Lisa Rae
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Critical Care and Intensive Care Medicine - Published
- 2022
4. Early neurological deterioration in older adults with traumatic brain injury
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Michael A. Horst, Richard Arbour, and Linda Jean Scheetz
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Male ,medicine.medical_specialty ,medicine.drug_class ,Traumatic brain injury ,medicine.medical_treatment ,Emergency Nursing ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,Secondary analysis ,Brain Injuries, Traumatic ,medicine ,Emergency medical services ,Humans ,Cognitive Dysfunction ,Glasgow Coma Scale ,Registries ,030212 general & internal medicine ,Mortality ,Psychiatry ,Aged ,Retrospective Studies ,Aged, 80 and over ,Rehabilitation ,business.industry ,Racial Groups ,Anticoagulant ,030208 emergency & critical care medicine ,Emergency department ,medicine.disease ,Emergency medicine ,Female ,Emergency Service, Hospital ,business - Abstract
Introduction Traumatic brain injuries (TBIs) and resulting fatalities among older adults increased considerably in recent years. Neurological deterioration often goes unrecognized at the injury scene and patients arrive at emergency departments with near-normal Glasgow Coma Scale (GCS) scores. This study examined the proportion of older adults experiencing early neurological deterioration (prehospital to emergency department), associated factors, and association of the magnitude of neurological deterioration with TBI severity. Methods This secondary analysis of National Trauma Data Bank Research Datasets included patients who were age ⩾65, sustained a TBI, and transported from the injury scene to an emergency department. Data analysis included chi-square analysis, t -tests, and logistic regression. Long-term anticoagulant/antiplatelet therapy was not associated with deterioration. Results Of the sample of 91,886 patients, 13,913 (15.1%) experienced early neurological deterioration. Adjusting for covariates, age, gender, head AIS max injury severity, and probability of death were associated with early deterioration. Patients with severe and critical head injuries had the highest odds of early neurological deterioration (OR=1.41 [CI=1.22–1.63] and OR=1.98 [CI=1.63–2.40], p Discussion/conclusions Prehospital providers, nurses, physicians, and other providers have opportunities to optimize outcomes from older adult TBI through early recognition of neurological deterioration, rapid transport to facilities for definitive treatment, and targeted rehabilitation.
- Published
- 2018
5. 1117: VENTILATOR AUTOTRIGGERING CONSEQUENT TO STROKE VOLUME AND RECOIL WITH VENOARTERIAL ECMO
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Richard Arbour
- Subjects
Critical Care and Intensive Care Medicine - Published
- 2021
6. Restraint Reduction, Restraint Elimination, and Best Practice
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Anna Purcell Kirk, Alanna Beckett, Patricia Rudd, Andrea McGlinsey, and Richard Arbour
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Restraint, Physical ,medicine.medical_specialty ,Evidence-based practice ,Perioperative nursing ,Leadership and Management ,medicine.medical_treatment ,Best practice ,MEDLINE ,Assessment and Diagnosis ,Nurse's Role ,Clinical nurse specialist ,Patient safety ,Patient satisfaction ,Nursing ,Perioperative Nursing ,Humans ,Medicine ,Reduction (orthopedic surgery) ,Advanced and Specialized Nursing ,business.industry ,LPN and LVN ,Intensive Care Units ,Evidence-Based Practice ,Emergency medicine ,Accidental Falls ,Patient Safety ,Nurse Clinicians ,business - Abstract
Purpose Baseline restraint prevalence for surgical step-down unit was 5.08%, and for surgical intensive care unit, it was 25.93%, greater than the National Database of Nursing Quality Indicators (NDNQI) mean. Project goal was sustained restraint reduction below the NDNQI mean and maintaining patient safety. Background/rationale Soft wrist restraints are utilized for falls reduction and preventing device removal but are not universally effective and may put patients at risk of injury. Decreasing use of restrictive devices enhances patient safety and decreases risk of injury. Description Phase 1 consisted of advanced practice nurse-facilitated restraint rounds on each restrained patient including multidisciplinary assessment and critical thinking with bedside clinicians including reevaluation for treatable causes of agitation and restraint indications. Phase 2 evaluated less restrictive mitts, padded belts, and elbow splint devices. Following a 4-month trial, phase 3 expanded the restraint initiative including critical care requiring education and collaboration among advanced practice nurses, physician team members, and nurse champions. Evaluation and outcomes Phase 1 decreased surgical step-down unit restraint prevalence from 5.08% to 3.57%. Phase 2 decreased restraint prevalence from 3.57% to 1.67%, less than the NDNQI mean. Phase 3 expansion in surgical intensive care units resulted in wrist restraint prevalence from 18.19% to 7.12% within the first year, maintained less than the NDNQI benchmarks while preserving patient safety. Interpretation/conclusion The initiative produced sustained reduction in acute/critical care well below the NDNQI mean without corresponding increase in patient medical device removal. Implications By managing causes of agitation, need for restraints is decreased, protecting patients from injury and increasing patient satisfaction. Follow-up research may explore patient experiences with and without restrictive device use.
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- 2015
7. Navigating the 7 Cs of Certified Practice
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Cynthia Webner, Carol Rauen, Carol Jacobson, Richard Arbour, and Karen M Marzlin
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Medical education ,Certification ,business.industry ,Communication ,Nurses ,General Medicine ,Continuity of Patient Care ,Critical Care Nursing ,Thinking ,Humans ,Medicine ,Cooperative Behavior ,Empathy ,business ,Referral and Consultation - Published
- 2014
8. Brain Death: Assessment, Controversy, and Confounding Factors
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Richard Arbour
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Male ,Brain Death ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Vital signs ,Poison control ,General Medicine ,Middle Aged ,Hypothermia ,Critical Care Nursing ,Pathophysiology ,Surgery ,Fasciculation ,Cerebral blood flow ,Injury prevention ,Humans ,Medicine ,Nursing Care ,medicine.symptom ,business ,Intensive care medicine ,Aged ,Cerebral angiography - Abstract
When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neuro diagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies. (Critical Care Nurse. 2013;33[6]:27-48)
- Published
- 2013
9. Traumatic Brain Injury
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Richard Arbour
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medicine.medical_specialty ,Traumatic brain injury ,business.industry ,Cardiopulmonary Physiology ,Hypothermia ,Critical Care Nursing ,medicine.disease ,Pathophysiology ,Cerebrospinal fluid ,Blunt ,Osmotherapy ,Anesthesia ,medicine ,medicine.symptom ,Intensive care medicine ,business ,Intracranial pressure - Abstract
Traumatic brain injury, which may be blunt or penetrating, begins altering intracranial physiology at the moment of impact as primary brain trauma. This article differentiates blunt versus penetrating brain trauma, primary versus secondary brain injury, and subsequent intracranial pathophysiology. Discussion and case study correlate intracranial pathophysiology and multisystem influences on evolving brain injury with mechanism-based interventions to modulate brain components (brain, blood, and cerebrospinal fluid volumes). The discussion also explores the effects of controlled ventilation, cardiopulmonary physiology, and global physiologic state on secondary injury, control of intracranial pressure, and recovery.
- Published
- 2013
10. Early Metabolic/Cellular-Level Resuscitation Following Terminal Brain Stem Herniation
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Richard Arbour
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Resuscitation ,Terminal (electronics) ,business.industry ,Emergency Medicine ,Medicine ,General Medicine ,Cellular level ,Critical Care Nursing ,business ,Bioinformatics - Abstract
Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability as well as biphasic cardiovascular state. Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. Cardiovascular dysfunction in phase 2 is a hypotensive state characterized by decreased systemic vascular resistance and tissue perfusion. Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states. A pronounced inflammatory state occurs, affecting pulmonary function and gas exchange and contributing to hemodynamic instability as a result of additional vasodilatation. Coagulopathy also occurs as a result of consumption of clotting factors as well as dilution of clotting factors and platelets consequent to aggressive crystalloid administration. Each consequence of terminal brain stem injury complicates clinical management within this patient demographic. In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor’s organs (liver, kidneys, heart, etc.) after death by neurological criteria. These processes begin far earlier in the continuum of injury, at the moment of terminal brain stem herniation. As such, aggressive, mechanism-based care, including hormonal replacement therapy, becomes clinically appropriate before formal brain death declaration to support cardiopulmonary stability following terminal brain stem herniation.
- Published
- 2013
11. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient
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Michael J. Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M. Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, and Sangeeta Mehta
- Subjects
Adult ,medicine.medical_specialty ,Brain Death ,Critical Illness ,Status Asthmaticus ,MEDLINE ,Neuromuscular Junction ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Hypothermia, Induced ,Pregnancy ,Intensive care ,Myasthenia Gravis ,Medicine ,Humans ,Hypnotics and Sedatives ,030212 general & internal medicine ,Obesity ,Intensive care medicine ,Neuromuscular Blockade ,Analgesics ,Respiratory Distress Syndrome ,Terminal Care ,Modalities ,business.industry ,Hemodynamics ,030208 emergency & critical care medicine ,Guideline ,Evidence-based medicine ,Intensive care unit ,Withholding Treatment ,Modes of mechanical ventilation ,Female ,Neuromuscular Monitoring ,Neuromuscular Blocking Agents ,business - Abstract
To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient."A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines. Annually, all members completed conflict of interest statements; no conflicts were identified. This activity was funded by the Society for Critical Care Medicine, and no industry support was provided.Using the Grading of Recommendations Assessment, Development, and Evaluation system, the Grading of Recommendations Assessment, Development, and Evaluation expert on the Task Force created profiles for the evidence related to six of the 21 questions and assigned quality-of-evidence scores to these and the additional 15 questions for which insufficient evidence was available to create a profile. Task Force members reviewed this material and all available evidence and provided recommendations, suggestions, or good practice statements for these 21 questions.The Task Force developed a single strong recommendation: we recommend scheduled eye care that includes lubricating drops or gel and eyelid closure for patients receiving continuous infusions of neuromuscular-blocking agents. The Task Force developed 10 weak recommendations. 1) We suggest that a neuromuscular-blocking agent be administered by continuous intravenous infusion early in the course of acute respiratory distress syndrome for patients with a PaO2/FIO2 less than 150. 2) We suggest against the routine administration of an neuromuscular-blocking agents to mechanically ventilated patients with status asthmaticus. 3) We suggest a trial of a neuromuscular-blocking agents in life-threatening situations associated with profound hypoxemia, respiratory acidosis, or hemodynamic compromise. 4) We suggest that neuromuscular-blocking agents may be used to manage overt shivering in therapeutic hypothermia. 5) We suggest that peripheral nerve stimulation with train-of-four monitoring may be a useful tool for monitoring the depth of neuromuscular blockade but only if it is incorporated into a more inclusive assessment of the patient that includes clinical assessment. 6) We suggest against the use of peripheral nerve stimulation with train of four alone for monitoring the depth of neuromuscular blockade in patients receiving continuous infusion of neuromuscular-blocking agents. 7) We suggest that patients receiving a continuous infusion of neuromuscular-blocking agent receive a structured physiotherapy regimen. 8) We suggest that clinicians target a blood glucose level of less than 180 mg/dL in patients receiving neuromuscular-blocking agents. 9) We suggest that clinicians not use actual body weight and instead use a consistent weight (ideal body weight or adjusted body weight) when calculating neuromuscular-blocking agents doses for obese patients. 10) We suggest that neuromuscular-blocking agents be discontinued at the end of life or when life support is withdrawn. In situations in which evidence was lacking or insufficient and the study results were equivocal or optimal clinical practice varies, the Task Force made no recommendations for nine of the topics. 1) We make no recommendation as to whether neuromuscular blockade is beneficial or harmful when used in patients with acute brain injury and raised intracranial pressure. 2) We make no recommendation on the routine use of neuromuscular-blocking agents for patients undergoing therapeutic hypothermia following cardiac arrest. 3) We make no recommendation on the use of peripheral nerve stimulation to monitor degree of block in patients undergoing therapeutic hypothermia. 4) We make no recommendation on the use of neuromuscular blockade to improve the accuracy of intravascular-volume assessment in mechanically ventilated patients. 5) We make no recommendation concerning the use of electroencephalogram-derived parameters as a measure of sedation during continuous administration of neuromuscular-blocking agents. 6) We make no recommendation regarding nutritional requirements specific to patients receiving infusions of neuromuscular-blocking agents. 7) We make no recommendation concerning the use of one measure of consistent weight over another when calculating neuromuscular-blocking agent doses in obese patients. 8) We make no recommendation on the use of neuromuscular-blocking agents in pregnant patients. 9) We make no recommendation on which muscle group should be monitored in patients with myasthenia gravis receiving neuromuscular-blocking agents. Finally, in situations in which evidence was lacking or insufficient but expert consensus was unanimous, the Task Force developed six good practice statements. 1) If peripheral nerve stimulation is used, optimal clinical practice suggests that it should be done in conjunction with assessment of other clinical findings (e.g., triggering of the ventilator and degree of shivering) to assess the degree of neuromuscular blockade in patients undergoing therapeutic hypothermia. 2) Optimal clinical practice suggests that a protocol should include guidance on neuromuscular-blocking agent administration in patients undergoing therapeutic hypothermia. 3) Optimal clinical practice suggests that analgesic and sedative drugs should be used prior to and during neuromuscular blockade, with the goal of achieving deep sedation. 4) Optimal clinical practice suggests that clinicians at the bedside implement measure to attenuate the risk of unintended extubation in patients receiving neuromuscular-blocking agents. 5) Optimal clinical practice suggests that a reduced dose of an neuromuscular-blocking agent be used for patients with myasthenia gravis and that the dose should be based on peripheral nerve stimulation with train-of-four monitoring. 6) Optimal clinical practice suggests that neuromuscular-blocking agents be discontinued prior to the clinical determination of brain death.
- Published
- 2016
12. Islam, Brain Death, and Transplantation
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Richard Arbour, Hanan Mesfer Saad AlGhamdi, and Linda Peters
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Emergency Medicine ,General Medicine ,Critical Care Nursing ,humanities - Abstract
A significant gap exists between availability of organs for transplant and patients with end-stage organ failure for whom organ transplantation is the last treatment option. Reasons for this mismatch include inadequate approach to potential donor families and donor loss as a result of refractory cardiopulmonary instability during and after brainstem herniation. Other reasons include inadequate cultural competence and sensitivity when communicating with potential donor families. Clinicians may not have an understanding of the cultural and religious perspectives of Muslim families of critically ill patients who may be approached about brain death and organ donation. This review analyzes Islamic cultural and religious perspectives on organ donation, transplantation, and brain death, including faith-based directives from Islamic religious authorities, definitions of death in Islam, and communication strategies when discussing brain death and organ donation with Muslim families. Optimal family care and communication are highlighted using case studies and backgrounds illustrating barriers and approaches with Muslim families in the United States and in the Kingdom of Saudi Arabia that can improve cultural competence and family care as well as increase organ availability within the Muslim population and beyond.
- Published
- 2012
13. 170: VENTILATOR AUTOTRIGGERING CONSEQUENT TO INTRA-AORTIC BALLOON PUMP COUNTERPULSATION
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Richard Arbour
- Subjects
medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,Medicine ,Critical Care and Intensive Care Medicine ,business ,Intra-aortic balloon pump - Published
- 2018
14. 291: BRAIN MONITORING, BISPECTRAL INDEX, EEG, HYPOTHERMIA: OUTCOMES PREDICTION AND OPTIMAL FAMILY CARE
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Barbara Bridge and Richard Arbour
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medicine.diagnostic_test ,business.industry ,Bispectral index ,Anesthesia ,Medicine ,Brain monitoring ,Hypothermia ,medicine.symptom ,Electroencephalography ,Critical Care and Intensive Care Medicine ,business - Published
- 2018
15. 761: BISPECTRAL INDEX EEG IN THERAPEUTIC HYPOTHERMIA: EEG DATA, HYPOTHERMIC STATE, AND OUTCOME PREDICTION
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Murray Flaster, Richard Arbour, and Barbara Bridge
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medicine.diagnostic_test ,business.industry ,Bispectral index ,Anesthesia ,Medicine ,Electroencephalography ,Hypothermia ,medicine.symptom ,Critical Care and Intensive Care Medicine ,business - Published
- 2018
16. Seven Evidence-Based Practice Habits: Putting Some Sacred Cows Out to Pasture
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Kathleen M. Vollman, Richard Arbour, Marianne Chulay, Elizabeth Bridges, and Carol A. Rauen
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Evidence-based practice ,Critical Care ,medicine.medical_treatment ,Posture ,Treatment outcome ,Nursing assessment ,MEDLINE ,Sodium Chloride ,Suction ,Critical Care Nursing ,Pasture ,Clinical Nursing Research ,Electrocardiography ,Habits ,Nursing ,Humans ,Medicine ,Intubation ,Glasgow Coma Scale ,Intubation, Gastrointestinal ,book ,Early Ambulation ,Nursing Assessment ,Specialties, Nursing ,geography ,Evidence-Based Medicine ,geography.geographical_feature_category ,business.industry ,Blood Pressure Determination ,General Medicine ,Nursing standard ,Benchmarking ,Instillation, Drug ,Treatment Outcome ,Nursing Evaluation Research ,book.journal ,Intracranial Hypertension ,business ,Algorithms ,Bed Rest - Published
- 2008
17. Predictive value of the bispectral index for burst suppression on diagnostic electroencephalogram during drug-induced coma
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Richard Arbour and Jonathan Dissin
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Adult ,Male ,medicine.medical_specialty ,Statistics as Topic ,Electroencephalography ,Alcohol Withdrawal Seizures ,Cohort Studies ,Consciousness Monitors ,Status Epilepticus ,Predictive Value of Tests ,Internal medicine ,Medicine ,Humans ,Consciousness monitors ,Prospective Studies ,Pentobarbital ,Propofol ,Coma ,Cerebral Cortex ,medicine.diagnostic_test ,Endocrine and Autonomic Systems ,business.industry ,Infarction, Middle Cerebral Artery ,Signal Processing, Computer-Assisted ,Middle Aged ,Predictive value ,Drug-induced coma ,Medical–Surgical Nursing ,Burst suppression ,Intensive Care Units ,Psychotic Disorders ,Bispectral index ,Predictive value of tests ,Cardiology ,Surgery ,Female ,Neurology (clinical) ,medicine.symptom ,Deep Sedation ,business - Abstract
To determine correlation and predictive value between data obtained with the bispectral index (BIS) and diagnostic electroencephalogram (EEG) in determining degree of burst suppression during drug-induced coma. This study seeks to answer the question: "To what degree can EEG suppression and burst count as measured by diagnostic EEG during drug-induced coma be predicted from data obtained from the BIS such as BIS value, suppression ratio (SR), and burst count?"During drug-induced coma, cortical EEG is the gold standard for real-time monitoring and drug titration. Diagnostic EEG is, from setup through data analysis, labor intensive, costly, and difficult to maintain uniform clinician competency. BIS monitoring is less expensive, less labor-intensive, and easier to interpret data and establish/maintain competency. Validating BIS data versus diagnostic EEG facilitates effective brain monitoring during drug-induced coma at lower cost with similar outcomes.This is a prospective, observational cohort study. Four consecutive patients receiving drug-induced coma/EEG monitoring were enrolled. BIS was initiated after informed consent. Variables recorded per minute included presence or absence of EEG burst suppression, burst count, BIS value over time, burst count, and SR. Pearson's product-moment and Spearman rank coefficient for BIS value and SR versus burst count were performed. Regression analysis was utilized to plot BIS values versus bursts/minute on EEG as well as SR versus burst count on EEG. EEG/BIS data were collected from digital data files and transcribed onto data sheets for corresponding time indices.Four patients yielded 1,972 data sets over 33 hours of EEG/BIS monitoring. Regression coefficient of 0.6673 shows robust predictive value between EEG burst count and BIS SR. Spearman rank coefficient of -0.8727 indicates strong inverse correlation between EEG burst count and BIS SR. Pearson's correlation coefficient between EEG versus BIS burst count was .8256 indicating strong positive correlation. Spearman's rank coefficient of 0.8810 and Pearson's correlation coefficient of .6819 showed strong correlation between BIS value versus EEG burst count. Number of patients (4) limits available statistics and ability to generalize results. Graphs and statistics show strong correlation/predictive value for BIS parameters to EEG suppression.This study is the first to measure correlation and predictive value between BIS monitoring and diagnostic EEG for degree of EEG suppression and burst count in the adult population. Available statistic tests and graphing of variables from BIS and diagnostic EEG show strong correlation and predictive value between both monitoring technologies during drug-induced coma. These support using BIS value, SR, and burst count to predict degree of EEG suppression in real time for titrating metabolic suppression therapy.
- Published
- 2015
18. Refractory Increased Intracranial Pressure in Severe Traumatic Brain Injury
- Author
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Richard Arbour, Mary Kay Bader, and Sylvain Palmer
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Adult ,Male ,Hypnosis ,medicine.medical_specialty ,Critical Care ,Leadership and Management ,medicine.drug_class ,Traumatic brain injury ,Sedation ,Nursing assessment ,Clinical Protocols ,Humans ,Hypnotics and Sedatives ,Medicine ,Intensive care medicine ,Pentobarbital ,Care Planning ,Nursing Assessment ,Intracranial pressure ,Neurologic Examination ,Advanced and Specialized Nursing ,Coma ,Evidence-Based Medicine ,Trauma Severity Indices ,Electromyography ,business.industry ,Patient Selection ,Decision Trees ,Electroencephalography ,Signal Processing, Computer-Assisted ,General Medicine ,medicine.disease ,Treatment Outcome ,Barbiturate ,Brain Injuries ,Anesthesia ,Bispectral index ,Practice Guidelines as Topic ,Drug Monitoring ,Intracranial Hypertension ,medicine.symptom ,business ,Algorithms - Abstract
Patients with severe traumatic brain injury resulting in increased intracranial pressure refractory to first-tier interventions challenge the critical care team. After exhausting these initial interventions, critical care practitioners may utilize barbiturate-induced coma in an attempt to reduce the intracranial pressure. Titrating appropriate levels of barbiturate is imperative. Underdosing the drug may fail to control the intracranial pressure, whereas overdosing may lead to untoward effects such as hypotension and cardiac compromise. Monitoring for a therapeutic level of barbiturate coma includes targeting drug levels and using continuous electroencephalogram monitoring, considered the gold standard. New technology, the Bispectral Index monitor, utilizes electroencephalogram principles to monitor the level of sedation and hypnosis in the critical care environment. This technology is now being considered for targeting appropriate levels of barbiturate coma.
- Published
- 2005
19. Clinical Management of the Organ Donor
- Author
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Richard Arbour
- Subjects
Brain Death ,medicine.medical_specialty ,Tissue and Organ Procurement ,Critical Care ,Leadership and Management ,Traumatic brain injury ,Resuscitation ,Patient Advocacy ,Disease ,Nurse's Role ,Organ transplantation ,Clinical Protocols ,Professional-Family Relations ,medicine ,Humans ,Family ,Intensive care medicine ,Care Planning ,Stroke ,Nursing Assessment ,Aged ,Intracranial pressure ,Advanced and Specialized Nursing ,Critically ill ,Mechanism (biology) ,business.industry ,Communication ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Tissue Donors ,Surgery ,Life Support Care ,Transplantation ,Female ,Advance Directives ,Nurse Clinicians ,Tomography, X-Ray Computed ,business - Abstract
There is a critical mismatch between available organs for transplant and acutely or critically ill patients with end-stage organ disease. Patients who may benefit from organ transplantation far outnumber available organs. The causes for this imbalance are multiple. One cause is family refusal to donate. A second cause is nonrecognition or delay in determination of brain death. A third cause is donor loss due to profound cardiopulmonary and metabolic instability consequent to brain-stem herniation and brain death. Family refusal may be addressed by education, public awareness, as well as close attention to social, cultural and ethical issues, and optimal communication with donor families. Brain death may be consequent to traumatic brain injury, ischemic versus hemorrhagic stroke, as well as massive cerebral anoxia/ischemic following cardiac arrest. Nonrecognition or delay in brain death determination may be addressed by clinician education and frequent clinical assessment to detect early stages of brain-stem herniation refractory to aggressive measures for control of intracranial pressure. Donor loss due to profound cardiopulmonary and metabolic instability may be addressed by aggressive, mechanism-based treatment for clinical instability based on affected body system, as well as measures to support metabolic activity at the cellular and tissue level in the brain-dead organ donor. This article explores cerebral physiology related to impending brain death and catastrophic intracranial pressure elevations. In addition, physiologic consequences of brain death are correlated with affected body systems and mechanism-based therapies to support organ function pending transplantation. Ethical/legal issues are explored as related to patient autonomy and optimal family outcomes. Effective family communication, astute clinical assessment, and optimal clinical management of the organ donor are illustrated using a case study approach, highlighting the role of the advanced practice nurse in donor management.
- Published
- 2005
20. Using Bispectral Index Monitoring to Detect Potential Breakthrough Awareness and Limit Duration of Neuromuscular Blockade
- Author
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Richard Arbour
- Subjects
Male ,Neuromuscular Blockade ,business.industry ,Conscious Sedation ,Epiglottitis ,General Medicine ,Awareness ,Middle Aged ,Pain management ,Critical Care Nursing ,Sedation procedure ,Anesthesia ,Bispectral index ,Humans ,Medicine ,Limit (mathematics) ,Neuromuscular blockade monitoring ,business - Published
- 2004
21. A Continuous Quality Improvement Approach to Improving Clinical Practice in the Areas of Sedation, Analgesia, and Neuromuscular Blockade
- Author
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Richard Arbour
- Subjects
Program evaluation ,Inservice Training ,Quality management ,Quality Assurance, Health Care ,Conscious Sedation ,Clinical nurse specialist ,Education ,Education, Nursing, Continuing ,Andragogy ,Nursing ,Humans ,Hypnotics and Sedatives ,Medicine ,Medical prescription ,General Nursing ,Monitoring, Physiologic ,Analgesics ,Neuromuscular Blockade ,business.industry ,Review and Exam Preparation ,Needs assessment ,Analgesia ,Neuromuscular Blocking Agents ,business ,Educational program ,Needs Assessment - Abstract
Background: Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. Methods: The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Results: Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. Conclusion: The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.
- Published
- 2003
22. 1892: VENTILATOR AUTOTRIGGERING IN A PATIENT FOLLOWING MASSIVE INTRACEREBRAL HEMORRHAGE AND BRAIN DEATH
- Author
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Richard Arbour and Chet A. Morrison
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Intracerebral hemorrhage ,business.industry ,Anesthesia ,Medicine ,Critical Care and Intensive Care Medicine ,business ,medicine.disease - Published
- 2016
23. 1690: EARLY HORMONAL RESUSCITATION AFTER NONSURVIVABLE BRAIN INJURY: IMPACT ON ORGAN RECOVERY
- Author
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Chet A. Morrison and Richard Arbour
- Subjects
medicine.medical_specialty ,Resuscitation ,business.industry ,medicine ,Critical Care and Intensive Care Medicine ,Intensive care medicine ,business - Published
- 2016
24. Mastering neuromuscular blockade
- Author
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Richard Arbour
- Subjects
Neuromuscular Blockade ,business.industry ,education ,Neuromuscular Junction ,Emergency Nursing ,Critical Care Nursing ,Neuromuscular Blocking Agents ,Analgesics, Opioid ,Humans ,Hypnotics and Sedatives ,Medicine ,Drug Interactions ,Drug Monitoring ,business ,Neuroscience ,Nursing Assessment - Abstract
Learn how neuromuscular blocking agents work and how to assess and manage a patient receiving these drugs.
- Published
- 2000
25. Propylene glycol toxicity related to high-dose lorazepam infusion: case report and discussion
- Author
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Richard Arbour
- Subjects
chemistry.chemical_compound ,chemistry ,business.industry ,Anesthesia ,Toxicity ,Medicine ,Lorazepam ,General Medicine ,Critical Care Nursing ,business ,Polyvinyl alcohol ,medicine.drug - Published
- 1999
26. Self-described nursing roles experienced during care of dying patients and their families: A phenomenological study
- Author
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Richard Arbour and Debra L. Wiegand
- Subjects
Adult ,Male ,medicine.medical_specialty ,Palliative care ,Critical Care ,Family support ,Nursing Staff, Hospital ,Positive memories ,Critical Care Nursing ,Critical Care and Intensive Care Medicine ,Nurse's Role ,Rigour ,Nonprobability sampling ,Young Adult ,Nursing ,Professional-Family Relations ,Critical care nursing ,medicine ,Humans ,Family ,Terminal Care ,business.industry ,Middle Aged ,Clinical Practice ,Family medicine ,Female ,Nurse-Patient Relations ,business - Abstract
Summary Background Critical care nurses frequently care for dying patients and their families. Little is known about the roles experienced and perceived by bedside nurses as they care for dying patients and their families. Objectives The purpose of this study was to understand the experiences of critical care nurses and to understand their perceptions of activities and roles that they performed while caring for patients and families during the transition from aggressive life-saving care to palliative and end-of-life care. Methods A descriptive, phenomenological study was conducted and a purposive sampling strategy was used to recruit 19 critical care nurses with experience caring for dying patients and their families. Individual interviews were conducted and audio-recorded. Coliazzi's method of data analysis was utilised to inductively determine themes, clusters and categories. Data saturation was achieved and methodological rigour was established. Results Categories that evolved from the data included educating the family, advocating for the patient, encouraging and supporting family presence, managing symptoms, protecting families and creating positive memories and family support. Participants also identified the importance of teaching and mentoring novice clinicians. Conclusions The results of this study have important implications for clinical practice, education and research for optimal preparation in providing end-of-life care.
- Published
- 2015
27. Aggressive management of intracranial dynamics
- Author
-
Richard Arbour
- Subjects
Critical Care ,Intracranial Pressure ,business.industry ,MEDLINE ,General Medicine ,Critical Care Nursing ,Data science ,Text mining ,Brain Injuries ,Cerebrovascular Circulation ,Humans ,Medicine ,Intracranial Hypertension ,business ,Monitoring, Physiologic - Published
- 1998
28. Islam, brain death, and transplantation: culture, faith, and jurisprudence
- Author
-
Linda Peters, Richard Arbour, and Hanan M. Alghamdi
- Subjects
medicine.medical_specialty ,Brain Death ,Tissue and Organ Procurement ,media_common.quotation_subject ,Culture ,Critical Care Nursing ,Islam ,Organ transplantation ,Faith ,Muslim population ,medicine ,Humans ,Organ donation ,media_common ,business.industry ,Jurisprudence ,Religion and Medicine ,General Medicine ,Organ Transplantation ,humanities ,Transplantation ,Family medicine ,Emergency Medicine ,business ,Cultural competence - Abstract
A significant gap exists between availability of organs for transplant and patients with end-stage organ failure for whom organ transplantation is the last treatment option. Reasons for this mismatch include inadequate approach to potential donor families and donor loss as a result of refractory cardiopulmonary instability during and after brainstem herniation. Other reasons include inadequate cultural competence and sensitivity when communicating with potential donor families. Clinicians may not have an understanding of the cultural and religious perspectives of Muslim families of critically ill patients who may be approached about brain death and organ donation. This review analyzes Islamic cultural and religious perspectives on organ donation, transplantation, and brain death, including faith-based directives from Islamic religious authorities, definitions of death in Islam, and communication strategies when discussing brain death and organ donation with Muslim families. Optimal family care and communication are highlighted using case studies and backgrounds illustrating barriers and approaches with Muslim families in the United States and in the Kingdom of Saudi Arabia that can improve cultural competence and family care as well as increase organ availability within the Muslim population and beyond.
- Published
- 2012
29. Confounding factors in brain death: cardiogenic ventilator autotriggering and implications for organ transplantation
- Author
-
Richard Arbour
- Subjects
Adult ,Male ,medicine.medical_specialty ,Brain Death ,Population ,Hemodynamics ,Context (language use) ,Neurological examination ,Critical Care Nursing ,Organ transplantation ,Young Adult ,Internal medicine ,Medicine ,Humans ,education ,Intensive care medicine ,education.field_of_study ,Ventilators, Mechanical ,Cardiac cycle ,medicine.diagnostic_test ,business.industry ,Confounding ,Confounding Factors, Epidemiologic ,Organ Transplantation ,Length of Stay ,Control of respiration ,Cardiology ,business - Abstract
Brain death is characterised by a flaccid, areflexic neurological examination; fixed, dilated and midpoint pupils and total absence of intrinsic respiratory drive. A non-reversible clinical state or brain lesion must also be identified. Integral to brain death diagnosis is loss of respiratory drive. Following terminal brainstem herniation, a cardiovascular hyperdynamic state often occurs. This hyperdynamic state causes cyclical volume displacement within the chest in phase with the cardiac cycle, causing oscillations in gas flow patterns and may be reflected in ventilator airway pressure and flow waveforms. When these flow/pressure waveform oscillations meet or exceed ventilator flow or pressure trigger sensitivity, ventilator breaths may be triggered in the total absence of intrinsic respiratory drive. In a patient with no apparent neurological function who is still triggering ventilator breaths, detailed analysis of ventilator pressure/flow waveforms in context with neurological assessment findings can identify cardiac autotriggering in a brain-dead patient. Undetected, cardiogenic ventilator autotriggering results in prolonged ICU stay and potential loss of transplantable organs. Collaborative practice and aggressive surveillance to determine loss of all neurologic function and evaluate possible autotriggering in this population is paramount and can minimise ICU stay, reduce costs of care, decrease family stress and facilitate recovery of transplantable organs.
- Published
- 2011
30. What you can do to reduce increased i.c.p
- Author
-
Richard Arbour
- Subjects
Adult ,Male ,Advanced and Specialized Nursing ,Pseudotumor Cerebri ,business.industry ,Computational biology ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing ,Patient Care Planning ,Text mining ,Humans ,Medicine ,business - Published
- 1993
31. Cardiogenic oscillation and ventilator autotriggering in brain-dead patients: a case series
- Author
-
Richard Arbour
- Subjects
Male ,medicine.medical_specialty ,Brain Death ,Apnea ,Respiratory physiology ,Critical Care Nursing ,law.invention ,Lesion ,Diagnosis, Differential ,Positive-Pressure Respiration ,law ,Internal medicine ,Oscillometry ,medicine ,Humans ,Aged ,Ventilators, Mechanical ,business.industry ,Heart ,General Medicine ,Middle Aged ,Intensive care unit ,Cardiovascular physiology ,Control of respiration ,Cardiology ,Respiratory Mechanics ,Female ,Brainstem ,medicine.symptom ,business ,Airway - Abstract
Brain death is manifested by a flaccid, areflexic patient on assessment of brain function with fixed and dilated pupils at midpoint, loss of consciousness, no response to stimulation, loss of brainstem reflexes, and apnea. A lesion or clinical state responsible for the loss of consciousness must be found. An integral part of clinical evaluation of brain death is apnea testing, which indicates complete loss of brainstem function and respiratory drive. Ventilator triggering or overbreathing the ventilator’s set rate may be considered consistent with intrinsic respiratory drive consequent to residual brainstem function. Ventilator autotriggering, however, may potentially occur in a brain-dead patient as a result of interaction between the hyperdynamic cardiovascular system and compliant lung tissue altering airway pressure and flow patterns. Also, chest wall and pre-cordial movements may mimic intrinsic respiratory drive. Ventilator autotriggering may delay determination of brain death, prolong the intensive care unit experience for patients and their families, increase costs, risk loss of donor organs, and confuse staff and family members. A detailed literature review and 3 cases of cardiogenic ventilator autotriggering are presented as examples of this phenomenon and highlight the value of close multidisciplinary clinical evaluation and examination of ventilator pressure and flow waveforms.
- Published
- 2009
32. Correlation between the Sedation-Agitation Scale and the Bispectral Index in ventilated patients in the intensive care unit
- Author
-
Richard Arbour, Linda Bucher, Julie K. Waterhouse, and Maureen A. Seckel
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,Sedation ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,law.invention ,Correlation ,law ,medicine ,Humans ,Hypnotics and Sedatives ,Prospective Studies ,Prospective cohort study ,Nursing Assessment ,Aged ,Mechanical ventilation ,Aged, 80 and over ,NEUROLOGIC CHANGES ,business.industry ,Electromyography ,Reproducibility of Results ,Electroencephalography ,Middle Aged ,Intensive care unit ,Respiration, Artificial ,Intensive Care Units ,Sedation agitation scale ,Bispectral index ,Anesthesia ,Equipment Failure ,Female ,medicine.symptom ,Drug Monitoring ,Cardiology and Cardiovascular Medicine ,business - Abstract
Oversedation masks neurologic changes and increases mortality/morbidity, whereas undersedation risks prolonged stress mobilization and patient injury. In situations such as deep sedation/analgesia, the Bispectral Index (BIS) has potential use as an adjunct to clinical assessment of sedation to help determine depth of sedation. Determining the correlation between clinical and BIS measures of sedation will help to determine the correct role of BIS in intensive care unit (ICU) practice settings.To evaluate the correlation between the clinical assessment of sedation using the Sedation-Agitation Scale (SAS) and the assessment using BIS in ventilated and sedated ICU patients.ICU patients requiring mechanical ventilation and sedation were monitored using the SAS and BIS. Nurses initiated event markers with BIS at the time of SAS assessment but were blinded to BIS scores.Data were collected on 40 subjects generating 209 paired readings. Moderate positive correlation between BIS and SAS values was shown with a Spearman Rank coefficient r value of .502 and an r(2) of .252 (P.0001). Wide ranges of BIS scores were observed, especially in very sedated patients. Strong positive correlation was noted between BIS and electromyography with an r value of .749 (P.0001). Age and gender significantly influenced BIS/SAS correlations.In situations in which the clinical assessment is equivocal, BIS monitoring may have an adjunctive role in sedation assessment. BIS values should be interpreted with caution, however, because electromyography activity and other factors seem to confound BIS scores. More research is necessary to determine the role of BIS monitoring in ICU practice.
- Published
- 2008
33. Impact of bispectral index monitoring on sedation and outcomes in critically ill adults: a case series
- Author
-
Richard Arbour
- Subjects
Adult ,Male ,medicine.medical_specialty ,Critical Care ,Sedation ,Conscious Sedation ,Critical Care Nursing ,Clinical Nursing Research ,medicine ,Humans ,Intensive care medicine ,Nursing Assessment ,Balance (ability) ,Aged ,Neurologic Examination ,Neuromuscular Blockade ,business.industry ,Critically ill ,Patient Selection ,Electroencephalography ,Signal Processing, Computer-Assisted ,Middle Aged ,Respiration, Artificial ,Clinical Practice ,Treatment Outcome ,Nursing Evaluation Research ,Bispectral index ,Linear Models ,Female ,medicine.symptom ,Drug Monitoring ,business - Abstract
In situations in which clinical assessment of sedation level is compromised, such as deep sedation/analgesia with and without neuromuscular blockade (NMB), electroencephalogram-based monitoring may potentially assist in achieving balance between inadequate and excessive levels of sedation. To validate the bispectral index (BIS) for use in clinical practice, correlation and possible differences in outcome using clinical assessment versus clinical assessment augmented by electroencephalogram-based monitoring were determined. BIS monitoring was decisive in ICU care in 9 of 15 patients in this series. The most significant potential benefit was obtained in the subset of patients receiving NMB.
- Published
- 2006
34. Intracranial hypertension: monitoring and nursing assessment
- Author
-
Richard, Arbour
- Subjects
Critical Care ,Humans ,Intracranial Hypertension ,Nursing Assessment ,Monitoring, Physiologic - Published
- 2004
35. Continuous nervous system monitoring, EEG, the bispectral index, and neuromuscular transmission
- Author
-
Richard Arbour
- Subjects
Nervous system ,Male ,Critical Care ,Leadership and Management ,Neuromuscular transmission ,Conscious Sedation ,Neurological examination ,Context (language use) ,Synaptic Transmission ,Arousal ,Paralysis ,Medicine ,Humans ,Wakefulness ,Care Planning ,Evoked Potentials ,Nursing Assessment ,Aged ,Monitoring, Physiologic ,Advanced and Specialized Nursing ,Neurologic Examination ,medicine.diagnostic_test ,business.industry ,Electroencephalography ,General Medicine ,Middle Aged ,Electric Stimulation ,medicine.anatomical_structure ,Anesthesia ,Bispectral index ,Peripheral nervous system ,medicine.symptom ,business - Abstract
In critically ill patients, the central nervous system remains vulnerable to multiple insults including ischemia, hemorrhagic events, and encephalopathy. The peripheral nervous system is vulnerable in the setting of neuro-muscular blockade (NMB), related drug-drug interactions, and drug-clinical state interactions. Optimal assessment of the nervous system is done by means of the clinical neurological examination. In this manner, orientation, arousal, and responsiveness to stimulation provide feedback on focal and global stability of the central nervous system. Where clinical evaluation is compromised, such as with deep sedation and NMB, risk of undetected seizure activity, and/or progression of neurological injury increases dramatically. A patient receiving NMB risks breakthrough awareness and pain. Long-term complications of NMB including prolonged weakness or paralysis as well as post-traumatic stress dramatically increase morbidity and length of stay. Technologies such as electroencephalogram (EEG) and bispectral index (BIS trade mark ) monitoring are effective for assessing cerebral function as well as level of sedation or arousal, respectively, in patients with a compromised neurological assessment. Neuromuscular transmission (NMT) monitoring by means of peripheral nerve stimulation and assessment of the evoked response may be utilized, within the context of clinical assessment, to determine level of chemical paralysis and minimize dosing of NMB agents. This article explores utilization and differentiates technologies such as EEG, BIS, and NMT monitoring. Monitoring parameters are illustrated using a case study approach.
- Published
- 2003
36. Sedation and pain management in critically ill adults
- Author
-
Richard Arbour
- Subjects
Adult ,Vasopressin ,medicine.medical_specialty ,Sympathetic nervous system ,Critical Care ,Sedation ,Critical Illness ,Conscious Sedation ,Pain ,Anxiety ,Critical Care Nursing ,chemistry.chemical_compound ,medicine ,Humans ,Hypnotics and Sedatives ,Intensive care medicine ,Nursing Assessment ,Psychomotor Agitation ,Analgesics ,Aldosterone ,business.industry ,Critically ill ,fungi ,food and beverages ,Delirium ,General Medicine ,Pain management ,medicine.anatomical_structure ,chemistry ,Practice Guidelines as Topic ,medicine.symptom ,Drug Monitoring ,business ,Antipsychotic Agents - Abstract
Critical illness can cause tremendous stress and can mobilize the stress response.1 The stress response can be beneficial in critical illness or injury by increasing output from the sympathetic nervous system and by increasing levels of aldosterone and vasopressin to maintain hemodynamic stability. The stress response can also cause complications.1 Anxiety, agitation, delirium, and pain are also potential consequences of critical illness2-5 and can mobilize the stress response. In the short-term, the stress response benefits hemodynamic stability; in the long-term, it can increase morbidity and mortality.1
- Published
- 2002
37. GETTING THROUGH YOUR FIRST CODE
- Author
-
Mary M. Bailey and Richard Arbour
- Subjects
Advanced and Specialized Nursing ,Programming language ,Computer science ,Resuscitation ,Anxiety ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing ,computer.software_genre ,Heart Arrest ,Code (cryptography) ,Humans ,computer - Published
- 1993
38. The Development of a Hepatology Care Coordination Program: An Effort to Achieve Reductions in Hospital Readmissions
- Author
-
Jessie Civan, She-Yan Wong, Brian F. Sweeney, Richard Arbour, Steven K. Herrine, Maria Neff, Jonathan M. Fenkel, David A. Sass, Dina Halegoua-De Marzio, and Ursula Hobbs
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Internal medicine ,Gastroenterology ,medicine ,Intensive care medicine ,business - Published
- 2014
39. Neurologic Critical Care
- Author
-
Karen March and Richard Arbour
- Subjects
Advanced and Specialized Nursing ,Focus (computing) ,Leadership and Management ,business.industry ,Medicine ,Engineering ethics ,General Medicine ,business ,Care Planning - Published
- 2005
40. Pain-related behaviors and pain assessment *
- Author
-
Richard Arbour
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,business.industry ,Pain assessment ,Noxious stimulus ,Physical therapy ,MEDLINE ,Medicine ,Critical Care and Intensive Care Medicine ,Cognitive impairment ,business - Published
- 2004
41. Barbiturate overdose
- Author
-
RICHARD ARBOUR
- Subjects
Advanced and Specialized Nursing ,Adult ,Male ,Phenobarbital ,Poisoning ,Humans ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing ,Nursing Assessment - Published
- 1995
42. Propylene Glycol Toxicity Occurs During Low-Dose Infusions of Lorazepam
- Author
-
Richard Arbour
- Subjects
chemistry.chemical_compound ,chemistry ,business.industry ,Anesthesia ,Toxicity ,Low dose ,Medicine ,Lorazepam ,Critical Care and Intensive Care Medicine ,business ,Polyvinyl alcohol ,medicine.drug - Published
- 2003
43. Laser and ultrasound technology in aggressive management of central nervous system tumors
- Author
-
Richard Arbour
- Subjects
Adult ,medicine.medical_specialty ,Neurological injury ,Ultrasonic Therapy ,Tumor resection ,Central nervous system ,Intraoperative ultrasonography ,Suction ,Central Nervous System Neoplasms ,Monitoring, Intraoperative ,Medicine ,Humans ,Ultrasonography ,Infection Control ,Family unit ,Endocrine and Autonomic Systems ,business.industry ,Ultrasound ,Surgical Injury ,Spinal cord ,Combined Modality Therapy ,Medical–Surgical Nursing ,medicine.anatomical_structure ,Treatment Outcome ,Surgery ,Female ,Neurology (clinical) ,Radiology ,Laser Therapy ,Safety ,business - Abstract
Tumors within the brain and spinal cord can have far-reaching effects on the health and long-term survival of the patient. In addition, implications of the diagnosis place stress upon the family unit. Until recently, aggressive management of these lesions carried the risk of additional neurological injury. With the rapidly expanding use of lasers, ultrasonic aspiration and real-time intraoperative ultrasonography, it is possible to aggressively resect tumors from within critical areas of the central nervous system, including the spinal cord. Additionally, it is possible to provide real-time evaluation of the operative field to assess tumor volume definition and completeness of tumor resection. This minimizes the risk of surgical injury and leads to improved patient outcomes.
- Published
- 1994
44. Stereotactic localization and resection of intracranial tumors
- Author
-
Richard Arbour
- Subjects
Surgical resection ,Adult ,Male ,medicine.medical_specialty ,Endocrine and Autonomic Systems ,business.industry ,Brain Neoplasms ,Stereotactic localization ,Stereotaxis ,Magnetic Resonance Imaging ,Resection ,Plan of care ,Cerebral Angiography ,Stereotaxic Techniques ,Medical–Surgical Nursing ,medicine ,Intracranial lesions ,Nerve tract ,Humans ,Surgery ,Neurology (clinical) ,Radiology ,business ,Tomography, X-Ray Computed ,Psychosurgery - Abstract
Stereotaxis has existed since the early 1900s, originating in Western Europe. Its practice was originally limited to isolation of nerve tracts, drainage of superficial abscesses and early attempts at psychosurgery. Today, with stereotactic-compatible imaging techniques and equipment, many types of intracranial lesions can be precisely localized and resected. Stereotactic approaches to therapy, including aggressive surgical resection, have become the treatments of choice for many types of potentially devastating lesions. A case study illustrates a stereotactic resection procedure, as well as the nursing plan of care and implications for the neuroscience nurse.
- Published
- 1993
45. Osmolar Gap Metabolic Acidosis in a 60-Year-Old Man Treated for Hypoxemic Respiratory Failure
- Author
-
Belen Esparis and Richard Arbour
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Sedation ,Lorazepam ,Critical Care and Intensive Care Medicine ,Rhonchi ,Hypoxemia ,Positive-Pressure Respiration ,Pyruvic Acid ,medicine ,Humans ,Hypnotics and Sedatives ,Lactic Acid ,Hypoxia ,Infusions, Intravenous ,Acidosis ,Neuromuscular Blockade ,business.industry ,Osmolar Concentration ,Oxygen Inhalation Therapy ,Metabolic acidosis ,Middle Aged ,medicine.disease ,Propylene Glycol ,Drug Combinations ,Respiratory failure ,Anesthesia ,Solvents ,Acidosis, Lactic ,medicine.symptom ,Respiratory Insufficiency ,Cardiology and Cardiovascular Medicine ,business ,Airway - Abstract
erally, upper airway rhonchi that cleared with endotracheal suctioning, and scattered expiratory wheezing. The abdomen was soft, and tenderness could not be assessed in the presence of neuromuscular blockade; however, bowel sounds were normal. Full neurologic assessment could not be performed due to the presence of sedation and neuromuscular blockade.
- Published
- 2000
46. Mastering neuromuscular blockade, part 2
- Author
-
Richard Arbour
- Subjects
Advanced and Specialized Nursing ,Neuromuscular Blockade ,medicine.medical_specialty ,business.industry ,Medicine ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing ,business ,Intensive care medicine ,Adjunct ,Surgery - Published
- 2000
47. Mastering neuromuscular blockade, part 1
- Author
-
Richard Arbour
- Subjects
Advanced and Specialized Nursing ,Neuromuscular Blockade ,Engineering ,Work (electrical) ,business.industry ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing ,business ,Neuroscience - Published
- 2000
48. Action Stat
- Author
-
Richard Arbour
- Subjects
Advanced and Specialized Nursing ,medicine.medical_specialty ,Heart block ,business.industry ,Assessment and Diagnosis ,Emergency Nursing ,LPN and LVN ,Critical Care Nursing ,medicine.disease ,Internal medicine ,medicine ,Cardiology ,Asystole ,business - Published
- 1994
49. actionSTAT!!
- Author
-
Richard Arbour
- Subjects
Advanced and Specialized Nursing ,business.industry ,Anesthesia ,Medicine ,Assessment and Diagnosis ,Emergency Nursing ,Acute hypoglycemia ,LPN and LVN ,Critical Care Nursing ,business - Published
- 1994
50. Neurologic Critical Care: One Focus, Many Contributions.
- Author
-
Richard Arbour
- Published
- 2005
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