Comprehensive Notes on Complex Adult Health, Critical Care, and End-of-Life Nursing

Critical Care Environment & Client Stressors

• Physical Environment Hazards and Interventions:

  • The Issue: Critical care units feature complex arrangements of wires, invasive tubing, and machinery necessary for life-sustaining care. Continuous artificial lighting disrupts normal circadian rhythms, resulting in heightened client agitation, disorientation, and delirium.

  • Nursing Interventions:

    • Orient clients and families thoroughly to all bedside equipment to mitigate anxiety and feelings of helplessness.

    • Maintain untangled and organized wires and tubing to prevent accidental displacement and care disruption.

    • Maximize natural day-night lighting cycles by uncovering windows when feasible.

    • Turn off non-essential artificial light sources and close room doors to block ambient hallway illumination.

• Noise Management Protocols:

  • Acoustic Thresholds: Optimal ambient noise standards are $35\,\text{dB}$ during daytime hours and $30\,\text{dB}$ at night.

  • Clinical Alarm Burden: Intensive care environments average $187$ device alarms per bed per day, with $72\%$ to $99\%$ representing false alarms. Common device sounds generate substantial decibel loads, such as raising the head of a bed ($68\,\text{dB}$) or an infusion pump alarm ($78\,\text{dB}$), which elevate stress-related health risks and hearing fatigue for clients, visitors, and clinicians.

  • Nursing Solutions:

    • Individualize device alarm parameters according to client clinical baselines to decrease false alarms.

    • Keep patient room doors closed to buffer external corridor sounds.

    • Implement dedicated unit quiet hours by blocking non-urgent phone calls into client rooms, prohibiting overhead paging systems, and lowering speech volume during night shifts.

• Sensory Deprivation Mitigation:

  • The Issue: Separation from home, normal routines, and family causes severe psychological distress. Analgesics and sedatives further limit client communication and engagement. Absence of environmental orientation cues causes loss of time perception.

  • Nursing Solutions:

    • Promote family presence and physical touch as permitted by institutional policy.

    • Encourage families to bring meaningful, small personal mementos to keep within the client's direct visual field.

    • Reorient alert clients regularly to time, date, and physical location, and maintain visible, accurate clocks and calendars.

    • Facilitate family updates regarding domestic and community events.

• Comparative Analysis of Critical Care Stressors:

  • Ranking by Client Category:

    • Postoperative Clients: 1. Thirst, 2. Tubes in mouth or nose, 3. Lack of control over self, 4. Inability to sleep, 5. Pain.

    • Medical Clients: 1. Thirst, 2. Lack of control over self, 3. Room temperature, 4. Inability to sleep, 5. Inability to use hands due to peripheral venous access devices (VAD).

  • Ranking by Age Demographics:

    • Age ${\le} 40$ Years: 1. Limited time with family and friends, 2. Thirst, 3. Tubes in mouth or nose, 4. Lack of control over self, 5. Pain.

    • Age $> 40$ Years: 1. Thirst, 2. Tubes in mouth or nose, 3. Lack of control over self, 4. Inability to sleep, 5. Pain.

• Targeted Nursing Actions for Specific Stressors:

  • Thirst: Provide oral fluids if clinically permitted; track strict fluid intake and output; apply cool-water oral swabs; deliver frequent oral hygiene; apply lip balm.

  • Tubes in Mouth or Nose: Secure tubing to prevent unnecessary motion; verify tubing exerts no direct pressure on mucosal linings or cutaneous tissue; reposition endotracheal tubes daily from one side of the mouth to the other; advocate for prompt extubation or tube removal when safe.

  • Lack of Control Over Self: Involve the client in setting daily care schedules; encourage expression of emotional concerns; educate on disease processes and prognosis; support gradual self-care independence.

  • Inability to Sleep: Cluster nursing activities to create uninterrupted rest periods; enforce unit quiet hours; adjust lighting and room temperature to preference; manage pain aggressively.

  • Peripheral VAD Hand Limitations: Avoid placing VAD lines in hand veins or across joint flexures (wrists or elbows); secure intravenous tubing with stockinette or gauze wraps to prevent line tugging.

  • Limited Family Time: Provide private visitation periods; facilitate telephone or video communications; answer family queries transparently.

• Physiologic Stress and Stress-Related Mucosal Disease (SRMD):

  • Pathophysiology: Severe illness triggers sympathetic nervous system activation, leading to high catecholamine release, systemic vasoconstriction, and inflammatory cytokine activity. This response causes gastric hypoperfusion by shunting splanchnic blood flow toward vital organs (brain, heart, lungs, kidneys). Prolonged ischemic hypoperfusion impairs the protective gastric mucosal barrier, creating stress ulcers that range from superficial mucosal erosion to deep muscular layer ulceration with massive gastrointestinal hemorrhage.

  • High-Risk Clinical Conditions: Respiratory failure requiring mechanical ventilation, coagulopathy (altered blood clotting), acute renal insufficiency, acute hepatic failure, sepsis, severe systemic hypotension, severe traumatic brain injury, or spinal cord injury.

  • Therapeutic Interventions: Administer prophylactic proton pump inhibitors (pantoprazole or rabeprazole), avoid systemic hypotension, and maintain adequate intravascular fluid volume.

Family Dynamics & The EPICS Family Bundle

• EPICS Family Bundle Protocol:

  • Evaluate: Assess family background, relationship structure to the client, current acute stressors, established coping strategies, baseline family needs, and preferred level of participation in care.

  • Plan: Anticipate care support needs, structure boundaries for family participation, establish routine communication updates, and encourage therapeutic physical touch.

  • Involve: Include family in multidisciplinary care discussions, invite input, hold structured family conferences, permit participation in basic comfort care, and personalize the patient room.

  • Communicate: Maintain complete transparency, deliver updates proactively, facilitate two-way conversations, ask about family well-being, and coordinate interactions with physicians.

  • Support: Act as a family advocate, offer practical assistance, supply community and institutional resources, display active empathy, mediate interdisciplinary conflicts, and offer professional referrals.

• Clinical Narrative on Supportive Care ("Tissue Nurses"):

  • A nursing student's father suffered a severe myocardial infarction and cardiac arrest on New Year's Eve, facing an initial $24\text{-hour}$ survival prognosis. During an extended three-week intensive care unit stay, the family observed that whenever physicians delivered grave clinical news, a nurse was consistently present. Rather than speaking, these nurses provided quiet, supportive presence, offering tissue boxes and physical touch to comfort grieving family members. This experience illustrates that critical care nursing extends beyond physical procedures to encompass compassionate emotional presence.

Application of the Nursing Process in Complex Adult Health

• High-Acuity Clinical Judgment Operations:

  • Critical care nurses manage one or two unstable clients requiring continuous, detailed physiological assessments and dynamic adjustment of complex interventions, contrasting with medical-surgical care of multiple stable clients.

• Phase-Specific Nursing Process Execution:

  • Assessment:

    • Prioritize direct physical assessment of the client over monitor readings.

    • Recognize subtle clinical deterioration cues early.

    • Maintain primary focus on Airway, Breathing, and Circulation (ABCs).

    • Perform high-frequency physical exams and continuous vital sign monitoring.

    • Utilize advanced skills including electrocardiogram (ECG) rhythm interpretation and internal cardiac or pulmonary arterial pressure monitoring.

  • Diagnosis/Analysis:

    • Analyze rapidly evolving clinical cues to guide emergency stabilization.

    • Execute standing protocols (e.g., titrating vasoactive infusions for sudden blood pressure shifts).

    • Manage complex, overlapping multi-system dysfunctions that obscure priority setting.

  • Planning:

    • Utilize standardized protocol bundles.

    • Plan care clusters to allow uninterrupted client rest.

    • Adapt plans rapidly as physiological parameters shift.

    • Incorporate family communication into daily schedules.

  • Implementation:

    • Manage life-sustaining biomedical equipment.

    • Maintain foundational hygienic care alongside advanced technical interventions, including meticulous skin hygiene and oral care (especially for intubated clients).

    • Maintain ongoing physical touch and verbal communication regardless of client responsiveness.

  • Evaluation:

    • Perform continuous re-assessments to measure intervention efficacy.

    • Analyze data trends to refine nursing actions in real time.

Interprofessional Communication & Safety Protocols

• TeamSTEPPS Framework:

  • Developed by the Agency for Healthcare Research and Quality (AHRQ) in collaboration with partner organizations to optimize interprofessional teamwork, response speed, and client safety during acute clinical events.

• ISBAR Communication Model:

  • A standardized tool used during care transfers, shift handoffs, emergency escalations, and interprofessional consultations to eliminate communication errors.

*   **Identify**: State name, professional role, unit location, and relevant credentials.
*   **Situation**: State the immediate reason for communication, client status change, acute lab result, or urgent event.
*   **Background**: Provide pertinent clinical context, admitting diagnosis, baseline assessment data, and history.
*   **Assessment**: Present current clinical findings, synthesis of facts, and diagnostic interpretation.
*   **Recommendation**: State specific requested actions, interventions, orders, or ongoing monitoring needs.

• Emergency Verbal Tactics:

  • Call-Out: A method used during emergency resuscitation (codes) to communicate critical data aloud to the entire team simultaneously, allowing anticipation of next steps and assisting the documentation recorder. Information must be directed to a specific individual.

  • Check-Back: A closed-loop communication technique to verify order accuracy:

    1. Sender states the message/order.

    2. Receiver repeats the message/order verbatim to confirm.

    3. Sender confirms correctness ("That is correct").

    • Safety Note: Designate one explicit healthcare provider to lead orders to prevent conflicting team directions.

• Structured Care Handoff ("I PASS the BATON"):

*   **Introduction**: Introduce self and role in care.
*   **Patient**: State client name, identifiers, age, sex, and bed location.
*   **Assessment**: Present chief complaint, vital signs, physical symptoms, and current diagnosis.
*   **Situation**: Describe current clinical status, code status, uncertainty level, recent changes, and treatment response.
*   **Safety Concerns**: Highlight critical lab values, socio-economic factors, allergies, and fall/isolation alerts.
*   **Background**: Detail medical comorbidities, past admissions, current medications, and family history.
*   **Actions**: State actions taken or pending, with brief clinical rationale.
*   **Timing**: State urgency level, explicit action timelines, and task prioritization.
*   **Ownership**: Clarify responsible team members (nurse, physician, specialty team) and family responsibilities.
*   **Next**: Detail expected upcoming care, plan changes, and contingency measures.
*   **Essential Handoff Principles**: Transfer both responsibility and authority; clarify all ambiguities before leaving; use direct verbal communication; require explicit receiver acknowledgment; review data together for safety.

• Interprofessional Daily Dialogue Checklist:

  • Conduct daily interprofessional rounds focusing on: discharge planning requirements; top safety risks; critical care bundle adherence; system evaluations (cardiac/hemodynamics, volume status, neuro, pain/agitation/delirium, sedation, GI/bowel, nutrition, skin integrity, activity, infection/cultures/antibiotic levels, labs, radiology); medication review; eligibility for central line, invasive catheter, or urinary catheter removal; family needs; code status and advance directives; provider notification parameters; daily goals.

Pain Assessment & Management Protocols

• The ABCDEF Bundle Protocol:

  • A (Assess, Prevent, and Manage Pain): Evaluate pain using validated nonverbal tools (CPOT, BPS). Combine multimodal pharmacologic management with non-pharmacologic measures.

  • B (Both Spontaneous Awakening Trials [SAT] and Spontaneous Breathing Trials [SBT]): Conduct daily un-sedated SATs and SBTs for mechanically ventilated clients while monitoring pain and agitation.

  • C (Choice of Analgesia and Sedation): Utilize an analgesia-first approach to manage discomfort before initiating sedatives, reducing delirium risk.

  • D (Delirium Assessment and Management): Screen regularly using tools such as the Confusion Assessment Method for the ICU (CAM-ICU) or Intensive Care Delirium Screening Checklist. Correct underlying causes (sepsis, hypoxia, electrolyte shifts, sleep loss). Improve sleep hygiene, encourage early mobility, ensure sensory aids (glasses/hearing aids) are present, and engage family.

  • E (Early Mobility and Exercise): Coordinate progressive mobility from passive range of motion to sitting, standing, and walking.

  • F (Family Engagement and Empowerment): Involve family actively in daily routines and reorientation.

• Validated Nonverbal Pain Assessment Tools:

  • Critical Care Pain Observation Tool (CPOT): Evaluates facial expression, body movements, muscle tension, and ventilator compliance (or vocalization in non-intubated clients). Total score ranges from $0$ to $8$ points.

    • Interpretation: Scores of $0\text{--}2$ indicate acceptable pain control; scores of $3\text{--}8$ indicate unacceptable pain requiring intervention.

  • Behavioral Pain Scale (BPS / BPS-NI): Validated for intubated (BPS) and non-intubated (BPS-NI) nonverbal clients.

• Analgesic Administration Guidelines:

  • Implement non-pharmacologic comfort interventions (rest clustering, position changes, family presence) for all clients regardless of pain score.

  • Administer prescribed analgesics based on objective observational scale scores, initiating therapy at the lowest effective dose and titrating according to response.

  • Always administer analgesic medications for pain control prior to initiating or escalating sedative agents.

Ethical & Legal Considerations in Complex Care

• Health Disparities & Social Determinants:

  • CDC Definition (2017): Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health experienced by socially disadvantaged population groups.

  • Demographic Data: Racial and ethnic minorities represent over one-third ($> 33\%$) of the U.S. population (2020 Census).

  • Contributing Factors:

    • Low-income status decreases health insurance access.

    • Lower educational attainment limits employment options offering health coverage.

    • Sex disparities result in males receiving cardiac interventions more frequently than females regardless of risk profile.

    • Racial disparities cause Black and Latino children to experience higher asthma hospitalization rates than white children.

    • Sexual and gender minorities face elevated risks of mental health conditions and victimization.

    • Disabled individuals face higher rates of medical neglect, isolation, and depression.

    • Rural populations face geographic barriers and transit deficits.

    • Immigrant groups experience reduced access to safe housing.

  • Health Equity and Social Justice: Equal access to quality care is a core tenet of social justice. Disparities shift untreated chronic conditions (asthma, diabetes, hypertension, obesity) into life-threatening acute crises requiring emergency or ICU admissions.

• Ethic of Care & Advocacy:

  • Nurses maintain an ethical duty to advocate for clients due to extended, intimate contact with vulnerable individuals. An ethic of care recognizes human interdependence, emphasizing compassion, collaboration, accountability, and trust.

• Seven-Step Ethical Dilemma Resolution Framework (Applied to Pandemic ICU Bed Allocation):

  1. Determine if an ethical dilemma exists: Confirm whether conflicting moral duties or resource limitations exist.

  2. Gather comprehensive data: Collect client, family, institutional, and social data (e.g., bed shortages, arrival method disparities).

  3. Clarify values: Distinguish factual data from opinions and moral values.

  4. Verbalize the problem: State the explicit core issue (e.g., resource deficits during sudden client surges).

  5. Identify options: Brainstorm potential courses of action (e.g., adapting discharge criteria, converting unit spaces, halting elective procedures).

  6. Negotiate a plan: Formulate an equitable strategy involving administrative, clinical, and community stakeholders.

  7. Evaluate the plan over time: Conduct ongoing reviews and debriefings to refine protocols based on emerging evidence.

• Legal Protections, Advance Directives, and Orders:

  • Autonomy & Decision-Making: The Patient's Bill of Rights protects client autonomy to direct or refuse medical care, even during emergencies. Managing client refusal or utilizing physical/chemical restraint/sedation to protect life-sustaining lines creates ethical stress for nurses.

  • Support & Consultation: Consult nursing supervisors, hospital ethics committees, or legal teams when facing complex conflicts (e.g., futile treatment demands, family disputes, incapacitated clients lacking surrogates).

  • Resuscitation Orders & Documentation:

    • Durable Power of Attorney for Healthcare (DPOA): Designates a surrogate decision-maker when the client lacks capacity.

    • DNR / Allow Natural Death (AND): In-facility medical orders detailing specific limits on resuscitative interventions.

    • Portable Orders for Life-Sustaining Treatment (POLST): Out-of-hospital medical orders recognized across care settings.

  • Role Responsibilities for Resuscuscitation Orders:

    • Client/Family: Understand refusal implications; present original, unaltered DNR documentation; accept that emergency resuscitation will proceed if valid documents are unavailable.

    • Healthcare Provider: Initiate resuscitation if documentation is absent; stop interventions if a valid DNR is found mid-code; assess terminal status and decision capacity; write specific facility orders.

    • Nurse: Verify document validity and client identity; start resuscitation if no document exists; notify the supervisor and physician if a valid DNR is discovered mid-code; execute valid orders; provide palliative comfort care.

• Moral Distress & Professional Self-Care:

  • Definition: Moral distress occurs when a nurse knows the ethically correct action to take but is constrained from acting by institutional rules, clinical pressure, or situational limitations, rendering the nurse a "second victim."

  • Manifestations: Physical symptoms (headaches, palpitations, gastric distress), emotional responses (anger, frustration, guilt, depression), and professional consequences (burnout, leaving the nursing profession).

  • Mitigation Strategies: Institutional debriefing sessions, quiet rest spaces during shifts, peer support, and Employee Assistance Programs (EAP).

Early Deterioration & Rapid Response Teams (RRT)

• In-Hospital Cardiac Arrest (IHCA) Prevention:

  • IHCAs carry poor survival rates. Clients display subtle physiological deterioration (mild confusion, tachypnea, subtle vital sign shifts) $6$ to $8$ hours prior to acute cardiac or respiratory arrest. Early identification prevents IHCA.

• Rapid Response Team Composition & Roles:

  • Bedside Nurse: Identifies early warning cues or family concerns; activates RRT; returns client to bed; clears furniture/bystanders; opens Electronic Health Record (EHR); verifies advance directives/DPOA status; delegates care of other assigned clients.

  • ICU Nurse: Delivers advanced critical interventions bedside; coordinates ICU transfer handoffs.

  • Respiratory Therapist: Assumes airway management; draws arterial blood gas (ABG) samples.

  • Nursing Supervisor: Documents event timeline; supports family; coordinates bed logistics for level-of-care transfers.

  • Pharmacist: Prepares, calculates, and advises on emergency drug therapy.

  • Healthcare Provider (Intensivist Physician or APRN): Directs emergency resuscitation, orders diagnostic tests, and manages primary provider communication.

• Three-Step RRT Operational Workflow:

  1. Recognize Worsening Condition: Detect shifts in heart rate, systolic blood pressure, respiratory rate, oxygen saturation, mental status, or urine output (components of Early Warning Scores), or act on an intuitive gut feeling regarding subtle behavioral shifts.

  2. Rapid Intervention: Execute standing emergency protocols without prior primary provider consultation (order labs, chest imaging, arterial lines; establish airway and oxygenation; administer emergency drugs; transfer to ICU).

  3. Debriefing & Quality Improvement: Conduct immediate post-event debriefs to review care decisions, provide peer emotional support, and educate bedside staff on early warning cues.

End-of-Life & Palliative Nursing Care

• Five Dimensions of End-of-Life Critical Care (WHO, 2020):

  1. Alleviation of physical symptoms (palliation).

  2. Open communication and conflict resolution.

  3. Withdrawing, limiting, or withholding non-beneficial therapies.

  4. Emotional and psychological support.

  5. Caregiver and team support.

• Core Goals of Palliative Care:

  • Regard dying as a normal biological process.

  • Provide relief from pain and distressing symptoms.

  • Affirm life while neither hastening nor postponing death.

  • Offer holistic support to optimize residual quality of life.

  • Help clients live actively until death.

  • Support families during illness and throughout bereavement.

• End-of-Life Communication Standards:

  • Maintain direct, transparent dialogue to establish trust.

  • Essential Discussion Points: Evaluate prognosis understanding; allow questions; clarify care goals; discuss palliative care versus aggressive life-sustaining interventions; establish structured communication plans.

  • Key Communication Skills: Empathy, reflection, intentional silence, and absolute honesty.

• Withdrawal of Life-Sustaining Treatment:

  • Ethically and legally distinct from euthanasia or assisted suicide; it allows natural disease progression to death.

  • Commonly Withdrawn Interventions: Mechanical ventilation (terminally weaned with opioids/sedatives titrated for dyspnea, tachypnea, or accessory muscle use); vasopressors; antibiotics; blood products; hemodialysis; enteral/parenteral nutrition (oral feeding offered if swallow function remains); continuous telemetry; deactivation of implanted cardioverter-defibrillators (ICDs) or pacemakers.

  • Clinical Tip: Administer comfort medications at doses effective to relieve pain and respiratory distress, even if the effective dose indirectly hastens death (Principle of Double Effect).

• Holistic Emotional & Psychological Care:

  • Involve non-traditional family structures (unmarried partners, close friends, informal relatives).

  • Respect preferences to exclude estranged family members who lack legal guardianship.

  • Utilize interdisciplinary resources (bereavement counselors, social workers, spiritual care/chaplains, mental health specialists).

  • Accommodate cultural traditions (e.g., using battery-operated candles, adjusting visitation hours for large family groups).

  • Maintain dignity by providing quiet, private spaces with chairs, tissues, refreshments, and personal items (prayer beads, blankets, music).

• Caregiver Support & Competencies:

  • The American Association of Colleges of Nursing (AACN) established the CARES recommendations ($1997$, revised $2016$), defining $17$ core end-of-life competencies for baccalaureate nursing programs to ensure practice readiness and address clinician moral distress and burnout.

Organ Donation Protocols & Donor Management

• Cultural Disparities in Organ Donation:

  • Ethnic minorities comprise $58\%$ of the national organ transplant waiting list but account for only $33\%$ of actual donors (LifeCenter Northwest, 2024), driving targeted OPO public education initiatives.

• Donor Exclusion Criteria:

  • Deceased Donors: Neurocognitive disorders (dementia, amyotrophic lateral sclerosis [ALS]); chronic systemic steroid therapy; collagen vascular diseases (systemic lupus erythematosus [SLE]); active septicemia or widespread infection; autoimmune disease (rheumatoid arthritis); communicable infections (HIV, active hepatitis); history of intravenous or injectable drug misuse; metastatic malignancy (corneas remain eligible for donation).

  • Living Kidney Donors:

    • Absolute Contraindications: Age $< 18$ years; uncontrolled systemic hypertension; diabetes mellitus; proteinuria ($> 300\,\text{mg/24 hours}$); abnormal Glomerular Filtration Rate (GFR); microscopic hematuria; high thromboembolism risk; major chronic disease (lung, cardiac, cancer); history of bilateral nephrolithiasis; HIV-positive status.

    • Relative Contraindications: Active chronic infection (tuberculosis, hepatitis B or C); obesity; active mental health alterations.

• Institutional Roles & Legal Mandates:

  • National Organ Transplant Act of 1984: Established the Organ Procurement and Transplantation Network (OPTN).

  • Medicare/Medicaid Hospital Mandates: Healthcare facilities must notify the local Organ Procurement Organization (OPO) of all impending or actual deaths. Bedside nurses are typically responsible for triggering timely OPO notifications.

  • Hospital Responsibilities: Maintain active OPO agreements; establish clinical trigger systems; collaborate on staff training, death record reviews, and donor physiological maintenance.

  • OPO Responsibilities: Evaluate donor medical suitability; ensure family notification of donation options; approach families to discuss donation and obtain legal consent.

  • Communication Rule: Healthcare providers and nurses handle clinical care and family comfort; designated OPO representatives approach the family regarding organ donation unless the family initiates the request.

• Legal Definition of Death:

  • According to the Uniform Determination of Death Act, death is defined as either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem.

• Physiological Parameters & Target Goals for Organ Donors:

  • Once brain death is declared, nursing care transitions from palliation to aggressive support of organ viability to optimize perfusion and tissue oxygenation:

• Pharmacological Strategies for Organ Preservation:

  • Blood Pressure Management: Vasodilators (nitroprusside, nicardipine) for hypertension; crystalloid fluids ($0.9\%$ normal saline) and vasopressors/inotropes (dopamine, dobutamine, norepinephrine, phenylephrine, vasopressin, desmopressin acetate [DDAVP]) for hypotension.

  • Myocardial Oxygen Demand Reduction: Beta-blockers (esmolol) to control catecholamine surges and reflex tachycardia.

  • Endocrine & Metabolic Support: Thyroid hormone replacement (liothyronine [T-3] or levothyroxine [T-1]); continuous insulin infusions for hyperglycemia; dextrose infusions for hypoglycemia.

  • Anti-Inflammatory Support: High-dose intravenous corticosteroids (methylprednisolone).

  • Polyuria / Diabetes Insipidus Treatment: Administer DDAVP or vasopressin; replace urinary fluid losses with $0.9\%$ normal saline.

  • General Physiological Support: Maintain normothermia, correct anemia with blood transfusions, treat coagulopathies/thrombocytopenia, maintain protective mechanical ventilation, and correct acid-base or electrolyte imbalances.