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atracurium infusions for the management of increased intracranial pressure
Continuous Midazolam/Atracurium Infusions for the Management of Increased Intracranial Pressure Four case studies are u s e d to discuss the benefits of a continuous midazolam/atracurium infusion in the treatment of uncontrolled intracranial hypertension. This combination was studied b e c a u s e it offered the following advantages: easy to administer, short half-life, and minimal adverse effects. Midazolam (Versed) is =a short-acting benzodiazepine with anxiolytic, sedative, antiepileptic, and amnesic properties. Its onset of action is within 1 to 5 minutes, and it is metabolized within 10 to 60 minutes. It has b e e n f o u n d to reduce cerebrospinal fluid pressure and to decrease cerebral b l o o d flow and cerebral oxyg e n c o n s u m p t i o n . A t r a c u r i u m is a n o n d e p o l a r i z i n g n e u r o m u s c u l a r b l o c k i n g agent with an onset of action within 1 to 5 minutes and an e x p e c t e d recovery within 20 to 40 minutes. Both drugs are given as an initial bolus followed b y a continuous infusion. The drugs are s t o p p e d 1 hour before the health care team evaluates the patient. This allows an examination without drug effect. The nursing care of a head-injured patient with sedative-paralytic treatment is outlined. H o w and w h e n to assess the neurologic status, which cardiovascular parameters are monitored, respiratory care, gastrointestinal function, and skin integrity are discussed. The n e e d for family education and s u p p o r t is stressed.
(McClelland M, Woster P, Sweasey T, HoffJT. Continuous midazolam/atracurium infusions for the management of increased intracranial pressure. J Neurosci Nurs 1995;2 7.96-101 .) Antibiotic-Induced Diarrhea Antibiotic-induced diarrhea b e c a m e a comm o n l y recognized p r o b l e m in the 1950s w h e n the use of antibiotics b e c a m e more common. This type of diarrhea ranges in severity from several mild w a t e r y stools per day to a disorder with pain, fever, electrolyte imbalances, and changes in the colon wall. P s e u d o m e m b r a n o u s colitis c a n result in a n d p r o c e e d to toxic m e g a c o l o n and colonic perforation. Almost all antibiotics have b e e n f o u n d to
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cause p s e u d o m e m b r a n o u s colitis, especially clindamycin, penicillins, and cephalosporins. Clindamycin w a s found to b e associated with a high incidence of this complication. Although a majority of the patients with antibiotic-induced diarrhea do not have an identifiable organism, b e t w e e n 15% to 25% are c a u s e d b y Clostridium difficile. Patients with a d v a n c e d age and more severe underlying disorders w e r e most at risk for C. difficile-related disease. N e w b o r n s and children rarely have C. difficile-related diarrhea despite frequent use of antibiotics. Nosocomial spread is a threat; therefore careful hand washing, universal precautions, and in severe cases isolating patients, is used to control cases. The most important m e t h o d to prevent cases is to limit the use of antibiotics for established purposes only.
(Vogel LC. Antibiotic-induced diarrhea. Orthop Nurs 1995; 14:38-41.) Trends in Death Associated with Traumatic Brain Injury, 1979 Through 1992, Success and Failure Traumatic brain injury (TBI) is a major health problem, accounting for o n e third of all injury deaths in the United States. In an effort to prevent n e w cases, understand the effects of TBI, and d e v e l o p optimal treatment, data were analyzed to m e a s u r e certain features. Because data sources regarding morbidity and disability are limited, death certificates w e r e used to collect information. The authors evaluated the Multiple Causeof-Death Public Use Data Tapes from the National Center for Health Statistics for 1979 through 1992. Cases w e r e selected according to cause-of-injury codes (E Code) and selected diagnosis c o d e s from the International Classification of Diseases, ninth revision. Analysis of data from the study period revealed TBI-associated deaths averaged 34%, or o n e third, of all injury deaths in the United States. From these data annual rates were calculated p e r 100,000 residents of the United States. The overall TBI-associated death rate declined 22% b e t w e e n 1979 and 1992. The TBI-
INTERNATIONAL JOURNAL OF TRAUMA NURSING/Abstracts of the Literature
VOLUME 1, NUMBER 4
(McClelland M, Woster P, Sweasey T, HoffJT. Continuous midazolam/atracurium infusions for the management of increased intracranial pressure. J Neurosci Nurs 1995;2 7.96-101 .) Antibiotic-Induced Diarrhea Antibiotic-induced diarrhea b e c a m e a comm o n l y recognized p r o b l e m in the 1950s w h e n the use of antibiotics b e c a m e more common. This type of diarrhea ranges in severity from several mild w a t e r y stools per day to a disorder with pain, fever, electrolyte imbalances, and changes in the colon wall. P s e u d o m e m b r a n o u s colitis c a n result in a n d p r o c e e d to toxic m e g a c o l o n and colonic perforation. Almost all antibiotics have b e e n f o u n d to
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cause p s e u d o m e m b r a n o u s colitis, especially clindamycin, penicillins, and cephalosporins. Clindamycin w a s found to b e associated with a high incidence of this complication. Although a majority of the patients with antibiotic-induced diarrhea do not have an identifiable organism, b e t w e e n 15% to 25% are c a u s e d b y Clostridium difficile. Patients with a d v a n c e d age and more severe underlying disorders w e r e most at risk for C. difficile-related disease. N e w b o r n s and children rarely have C. difficile-related diarrhea despite frequent use of antibiotics. Nosocomial spread is a threat; therefore careful hand washing, universal precautions, and in severe cases isolating patients, is used to control cases. The most important m e t h o d to prevent cases is to limit the use of antibiotics for established purposes only.
(Vogel LC. Antibiotic-induced diarrhea. Orthop Nurs 1995; 14:38-41.) Trends in Death Associated with Traumatic Brain Injury, 1979 Through 1992, Success and Failure Traumatic brain injury (TBI) is a major health problem, accounting for o n e third of all injury deaths in the United States. In an effort to prevent n e w cases, understand the effects of TBI, and d e v e l o p optimal treatment, data were analyzed to m e a s u r e certain features. Because data sources regarding morbidity and disability are limited, death certificates w e r e used to collect information. The authors evaluated the Multiple Causeof-Death Public Use Data Tapes from the National Center for Health Statistics for 1979 through 1992. Cases w e r e selected according to cause-of-injury codes (E Code) and selected diagnosis c o d e s from the International Classification of Diseases, ninth revision. Analysis of data from the study period revealed TBI-associated deaths averaged 34%, or o n e third, of all injury deaths in the United States. From these data annual rates were calculated p e r 100,000 residents of the United States. The overall TBI-associated death rate declined 22% b e t w e e n 1979 and 1992. The TBI-
INTERNATIONAL JOURNAL OF TRAUMA NURSING/Abstracts of the Literature
VOLUME 1, NUMBER 4