Biomedical subjects

E V Robins

Publications and source records attributed to E V Robins.

4 recordsLinked to original sources

PubMed1997

Developing a competency-based program for conscious sedation.

This article reviews the growth of IVCS usage from OR to bedside, including criteria set by professional organizations and regulatory agencies, and presents the development of a competency-based program for the IVCS monitor. The planning and implementation process for the IVCS competency program is discussed in terms of phases selection of IVCS monitoring staff, training of staff, competency verification, and competency maintenance. Because health care institutions must address the professional and regulatory standards of practice in IVCS, quality management activities are essential.

Competency-Based Education↗

PubMed1990

Burn shock.

The approach to fluid resuscitation in burn shock continues to be refined in step with improved knowledge of the complex fluid, electrolyte, and protein shifts that characterize this form of shock. Local burn tissue and generalized nonburn tissue edema occur initially after injury because of the release of histamine, which causes increased microvascular permeability. Subsequent edema formation in burned and nonburned tissue occurs according to distinctly different mechanisms. Burn tissue edema forms because of direct thermal injury to endothelial cells and increased burn tissue osmolarity. Nonburn tissue edema is attributed to severe hypoproteinemia caused by protein flux into burn-injured tissue. Interstitial protein depletion in nonburn tissue also increases the ease of water transport into the interstitial space. Cell damage occurs with ischemia caused by decreased perfusion. More cell damage can occur with reperfusion and the subsequent formation of oxygen radicals. Fluid therapy is designed to support the patient's cardiovascular system so as to restore and maintain tissue perfusion. General formulas serve as guidelines for the amount of fluid to infuse; however, fluid therapy should be tailored to the individual patient's needs based on factors such as extensiveness of burns, extremes of age, inhalation injury, pre-existing cardiopulmonary disease, and delayed fluid resuscitation. Ringer's lactate solution is the most common fluid used in the early postburn period. The addition of colloid to resuscitation efforts should begin as microvascular permeability is restored or immediately if the patient presents in frank shock. Continuous monitoring is necessary to judge the adequacy of fluid replacement.

Burns↗

PubMed1989

Immunosuppression of the burned patient.

The burn patient is highly susceptible to infection due to the loss of the skin as a barrier to microorganisms. Immune defenses are activated in response to the burn injury; however, some of these defenses are altered. Neutrophil chemotaxis is compromised by decreased perfusion caused by hypovolemia and the formation of microthrombi. Chemotaxis and phagocytosis are dependent on complement components that are reduced in a large burn wound. Neutrophil intracellular killing power is reduced as oxygen delivery to the wound is decreased. Humoral immunity is altered with the drop in IgG levels. Cell-mediated immunity is depressed and T cell lymphocyte counts are deceased. Suppressor T cells are generated. Specific sources of infection for the burn patient include the patient's own bacterial flora; hospital personnel; respiratory equipment; and catheters, both urinary and intravascular. The best control for burn wound infection is the closure of the wound by early excision and grafting. When lack of donor sites prohibits this surgical therapy, control centers on the environment and wound care techniques. The selection of wound topical antibiotics on the basis of visual inspection and surface culturing assists in the prevention of burn wound sepsis. When wound sepsis does occur, systemic antibiotics are instituted. Although burn wound sepsis is an obvious cause of death for the burn patient, it is not the primary cause. Increasing sophistication in fluid resuscitation and in intensive care therapy has resulted in patients living beyond the initial insult and the following few days. Burn patient mortality is now associated with a syndrome presenting clinically as sepsis but without any identifiable septic source.(ABSTRACT TRUNCATED AT 250 WORDS)

Burns↗

PubMedDate not supplied

A strategy for responding to the training needs of nursing staff in a new cardiac/neurosurgical ICU and telemetry unit.

The decision of the Brigham and Women's Hospital (BWH) to expand its capacity to care for acute cardiac surgical and neurosurgical patients resulted in the need for an education and training program for a large group of nursing staff. In such situations, where an existing service is being expanded or a new service initiated, nursing education departments must quickly devise simple and cost-effective mechanisms to promote the competency of nursing staff. Nurse educators, staff nurses, nurse managers, and clinical nurse specialists all play a role in planning and implementing the relevant education and evaluation program. BWH chose to recruit temporary special projects staff nurses to address these increased educational needs.

Cardiology↗