?Medical decision making? for repeated computed tomography in neurosurgical intensive care patients

1994 ◽  
Vol 17 (2) ◽  
pp. 141-144 ◽  
Author(s):  
Wolfgang A. Dauch ◽  
Kristian D. Szilagyi
Keyword(s):  
Computed Tomography ◽  
Decision Making ◽  
Intensive Care ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Intensive Care Patients ◽  
Neurosurgical Intensive Care

798 Introduction of Bedside Echocardiography by Mid-level Providers into Burn Intensive Care

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S235-S236
Author(s):  
Michael G Chambers ◽  
Garrett W Britton ◽  
Leopoldo C Cancio
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Medical Decision Making ◽  
Point Of Care ◽  
Physical Exam ◽  
Medical Decision ◽  
Point Of Care Ultrasound ◽  
Laboratory Findings ◽  
Radiographic Findings ◽  
Us Findings

Abstract Introduction Point-of-care ultrasound (US) has been shown to be a useful adjunct in assessment of various shock states and has been utilized to guide both resuscitation and post-resuscitation de-escalation. We aimed to characterize the use of bedside ultrasound examinations performed by advance practice providers (APPs) and attending physicians in a burn intensive care unit (BICU). Methods We introduced routine US by an APP into our BICU and evaluated our experience under an approved PI project. Daily beside US exams were performed utilizing a portable US machine with a cardiac probe and tissue filter. US exams included focused transthoracic echocardiography, assessment of inferior vena cava diameter with distensibility/collapsibility indices, and pulmonary evaluation. The images were archived to a centralized repository and reviewed daily during multi-disciplinary rounds. US data were utilized in conjunction with physical exam, radiographic, and laboratory findings for medical management decision making. Results Thirty-four exams of 34 patients have been conducted to date. 91% of US findings corresponded to physical, laboratory, and radiographic findings, and contributed positively to medical decision making. 9% of US findings either did not contribute to medical decision making or conflicted with physical exam, radiographic, or laboratory findings. Conclusions Our results demonstrate the feasibility of routine US by an APP in the BICU, and indicate that bedside US helps guide both resuscitative and post-resuscitative care. Applicability of Research to Practice It is well known that positive fluid balance is associated with worse clinical outcomes. We believe point-of-care US is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.

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