By: Maureen Lavino RN CCRN & Karen D. Doll RN CCRN
Maureen Lavino RN,CCRN has been employed at Horton Medical
Center in Middletown, N.Y. since 1982 and has been a Critical
Care Nurse since 1986. She received her CCRN certification
in 1997 and is a member of the national chapter of the
American Association of Critical Care Nurses. She is an
active member of the Nursing Quality assurance Council
Karen D. Doll RN CCRN has been a critical care nurse
at Horton Medical Center in Middletown, NY since 1985.
She received her CCRN certification in 1996 and is a member
of the national chapter of the American Association of
Critical Care Nurses. She has a Bachelor of Science degree
and is currently enrolling in Excelsior College to ultimately
work toward her Master's degree in Nursing Education.
eFastFacts For Adult Critical Care for the Palm OS by Kathy
White Learning Systems is available now. The Pocket PC
version is scheduled for release in July 2002. The electronic
version contains 100% of the original Fast Facts text and
over 90% of the original graphics. This evaluation is for
the pre-release (Beta) version of eFastFacts.
eFastFacts is a new PDA program that will quickly become
a key reference tool for anyone who practices in a critical
care setting. From the student of emergency medicine, to the
most seasoned professional, there is something here for everyone.
eFastFacts provides information on a wide variety of topics
that pertain to a diverse selection of ICU/CCU diagnoses,
treatments, medications, procedures, and protocols. Every
screen you open on a topic will give you additional links
to specific medications, definitions, and numerous graphics
that support the main topic.
The Palm OS application consists of a self-executing
compacted file (Palm_Install.exe) and readme.txt. for a total of
1.24MB. eFastFacts requires less than 1 MB of memory on the Palm
devices, which is hard to believe when you discover the wealth of
information that it contains. It uses minimal space considering
the very large quantity of text, graphics, and calculator capability
that is built into the program.
Installation of this program to the newer Palm m515 PDA was effortless
and without any difficulty. Following the prompts on the setup,
it went easily to the PDA with the next 'sync' process. Initially
we were surprised to see two icons on the device, eFastFacts and
eFF_Content. Subsequent investigation of both icons revealed the
eFF_Content icon is the database file and will then direct you to
the other icon that will open the full version of this program.
The attempted installation of this program to a Handspring Visor
Platinum did fail however. After the hotsync, we received a message
that Palm WebClippings Application was not installed on this device
and that it was required to view the eFastFacts PDQ content. Subsequently,
a Sony Clie s360 was sent to us from the company with the software
already loaded for us to continue with this evaluation.(Editors
Note: The company has reported difficulties
in utilizing WebClippings and eFastFacts on Handspring products)
We found out that eFastFacts will run on most Palm OS devices running
OS 3.5 (with the WebClippings installed, which requires an additional
150K of memory) or the OS 4.0 (that comes pre-loaded with WebClippings).
It will also be compatible with the soon to be released Palm OS
Due to the complexity of the program, the interlinking of text,
extensive graphics, and the programmed calculators for loading dose
and maintenance drip infusion calculations, the program must be
loaded into, and run from, the main memory. The application will
not run from SD cards, CF cards, Springboard Modules, MutiMedia
cards or Sony's Memory Sticks.
Once installed on the PDA, this program was easy to navigate from
the first time we opened it. Help files are available both on the
device as well as on the desktop for those that need assistance
in navigating the program. Links to the website www.kathywhite.com
is offered for additional FAQ files and for future updating of the
program on your PDA. A support system is under development that
will have the ability to provide assistance through email and even
phone contact if needed.
To start the program, you select the icon entitled eFastFacts.
From the 'home' drop down list, you will find a complete listing
of commonly used medical abbreviations, as well as the disclaimer,
and the option for changing the font for easier screen viewing.
At the top of the screen to the right is a drop down list where
you can access the individual chapters as well as the calculators.
|For instance, under the chapter Hemodynamics,
you will find numerous options including how to set up PA and
arterial lines, complete with graphics showing equipment set
up, pressure waveforms, and cardiac output procedures. Here
you can also access a full description of various causes and
treatments for hemodynamic instability and shock. Under the
Cardiovascular option, there is information that covers coronary
anatomy, assessment, interventions, and treatments for such
diagnoses as aortic dissection, pericarditis, heart failure,
DVT, and AICD implants. A complete review of ECG analysis with
3-, 5- and 12-lead systems is available, including dysrythmias,
axis interpretation, and localization of infarcts. Under Pacing,
you will find full information needed for pacemaker insertions
and descriptions (permanent, transvenous, and epicardial) that
include equipment set up, care, and troubleshooting.
Under the Respiratory option, you will find a complete description
of assessment of breath sounds, causes of hypoxemia, O2 delivery
devices, ABG interpretation, modes of ventilation and weaning parameters.
Diagnosis descriptions covered in full detail include pneumothorax,
embolism, ARDS, and effusions with directions on insertions procedures,
equipment setup and care of chest tubes and drainage units.
|There is even a Neuro section that will give you
detailed information on CNS structure, function, and assessment.
ICP monitoring device descriptions with equipment requirements
and instructions on how to obtain measurements are included
for both Bolt and IVC systems, including fiberoptic catheters.
Graphics for the ICP waveforms and equipment are available along
with PINS (train of four) use and care. Also under this topic
you will find AHA guidelines for risks, diagnostic tests, and
treatment of various intercranial hemorrhages, status epilepticus,
DT's, and brain death. Organ Donor management is also covered
in detail in this section.
Under the IV/Blood section, you will find descriptions of various
IV solutions, crystalloids and colloids, including blood products
and transfusion needs, along with specific electrolyte imbalances
and their treatment. The Labs/Charts screen will give you normal
values for ABGs, isos, chemistries, hematology, and immunology,
as well as normal findings for CSF and urine. There also is a comprehensive
listing of normal and toxic levels for antibiotics, ethanol, and
a wide variety of commonly used medications that need frequent drug
|A key requirement in any ICU is the need for a
quick reference to emergency medications and guidelines. Under
the section StatMeds, one can quickly access a full listing
of frequently used emergency medications that include usual
dosing, dilutions, and method of administration. After looking
up the medications, you can quickly go to the Calculations screen
to find both a loading dose and continuous infusion calculator
that is very simple to use. A quick entering of the weight,
drug concentration, and desired dose will easily convert to
an accurate rate of infusion. Here also you can find conversion
calculators for BSA, height, Fahrenheit/Centigrade, and IV drip
A separate section is provided for MedFacts where you can look
up various types of medications and uses, from ace inhibitors, epidural
analgesics, and neuromuscular blockades to sepsis and thrombolytic
medications. We were especially pleased to see the current and up
to date inclusion of Xigris with its administration procedure and
To top it all off, there is a complete ACLS section with a full
set of current algorithms and including all ACLS topics such as
coronary syndromes, intubation, defibrillation, pacing and acute
ischemic stroke protocol.
We especially liked the tremendous variety of information available
in one program as our ICU is a combined ICU/CCU/SICU and we need
to have knowledge in all aspects of critical care regarding the
patient's diagnosis, procedures, treatments and medications. This
ONE program gives it all. With eFastFacts information is readily
available and easily accessible. As a PDA program, it is lightweight
and portable, easy to keep in your pocket for a quick reference.
There were a few improvements we thought we might suggest for future
versions. One would be the integration of the two icons with the
initial installation into only one icon. This may eliminate some
confusion and screen space as you do not need to see the database
icon in order for the program to work. In the Calculations screen,
a few additional conversions that are frequently used in the ICU
could be added. For instance, we occasionally use the corrected
calcium, corrected sodium, mean arterial pressure, anion gap, rule
of six, and infusion management calculations as shown on the free
MedCalc program we have. Also, the inclusion of TNKase (tenecteplase)
as a thrombolytic agent would be beneficial to those of use who
do use this drug occasionally. However, as with all programs of
this type, the ability to update eFastFacts according to new trends
in critical care will remain a major benefit to the continued usefulness
of this program.
In the future, we will be able to update this program at the Kathy
White website in order to keep current with the trends. We are told
that specialty chapters currently available for the book version
(IABP, Trauma, Pediatrics, CV surgery) will also be integrated into
a PDA format that will complement this program to assist those who
need more specific information for these specialty services.
eFastFacts retails for $44.95, much less than other references
available, yet contains so much more pertinent and detailed information.
We know that once you discover the wealth of information it holds,
you will never want to be without it in a busy critical care unit.
Maureen can be contacted by email
Karen can be contacted by email
Editor's notes: In view of the difficulties
experienced by the review team in loading the application on to
a Handspring product, and the stringent minimum requirements of
the Palm OS application, it is strongly recommended that you review
the "System Requirements for Installing eFastFacts" listed
page of the company's website and request the free 15 day trial
version by emailing eFastFacts_Support@oms3.com
before purchasing the application.