Archive for the “Critical Care” Category

Posted on 29 Oct 2014
Critical Care

Tracheostomy in Canadian Pharmacy

Notwithstanding the patient’s deteriorated general condition, the procedure was performed in an outpatient setting, with no complications. Follow-up bronchoscopy 1 week later revealed localized mucosal edema and moderate secretions. Ten months later, the patient’s condition is stable, with only minimal and nonsignificant granulation tissue formation New Zealand Pharmacy. Tracheostomy

A 68-year-old man was referred to our Pulmonary Institute on August 2000 due to worsening dyspnea. At the age of 3 years, the patient had had severe diphtheria, complicated by respiratory insufficiency. The patient was therefore intubated and put on mechanical ventilation for 4 weeks. Subsequently, a subglottic obstruction developed that progressed and eventually required tracheostomy. Four years later, the tracheostomy was closed, but the patient continued to have chronic dyspnea. On hospital admission, the patient was found to be moderately dyspneic, with mild inspiratory stridor.

Soon after, the patient’s condition rapidly deteriorated, necessitating urgent tracheostomy. Bronchoscopy revealed severe subglottic obstruction, and laser treatment was applied. During the next 3 months, the patient had several hospital admissions for laser applications. Eventually, a metal Wallstent (64/14 mm) was inserted, and decannulation was performed. Shortly thereafter, the respiratory complaints recurred. One month after the stent insertion, on November 2000, significant formation of granulation tissue along the inner surface of the stent was identified.

Laser treatment was then applied, and the patient was transferred to the Radiotherapy Unit for HDR brachytherapy. The procedure was performed without any complications, and after a few hours the patient was discharged. It was only then that the patient’s condition stabilized. Almost a year later, the patient is still free of respiratory complaints, with only minimal granulation tissue formation observed in one of the subsequent bronchoscopies.

Posted on 16 Oct 2014
Critical Care

Seventy-three patients developed 106 lower respiratory tract infections

Statistical analyses were carried out using SAS 9.1 (SAS Institute Inc) and S-Plus 7.0 (Insightful Corporation).

Results

Two hundred twelve stent procedures were identified. Eight were excluded because multiple stent types were placed. Three procedures with Montgomery T-tubes and six with Polyflex stents (Boston Medical) were excluded because there were too few of the stents placed to analyze. The study included 172 patients with 195 stent procedures. Ultraflex stents were used Kamagra Australia in 118 cases (60%), Aero (Merit Endotek) stents were used in 31 (16%), and Novatech Dumon silicone bronchial and Y-stents (Boston Medical) were used in 46 (24%). Patient characteristics and complication rates are summarized in Tables 1 and 2.

Infection

Seventy-three patients developed 106 lower respiratory tract infections. The median time to infection was 1 month (range, 0-35 months). Respiratory infections led to significant morbidity and mortality: more than one-half of the patients were hospitalized, and 23% of patients with respiratory infections died within 14 days of their infection (Table 3). On univariate and multivariate analysis (Tables 4, 5), only Aero stents (hazard ratio [HR] = 1.98; 95% CI, 1.03-3.81; P = .041) (Fig 1) had a significant effect on infection risk.

Stent Migration and

Because Y-shaped stents do not typically migrate, we excluded 28 Y stent cases from the migration analysis. Among the remaining 167 procedures, 27 stent migrations occurred. The median time to stent migration was 1.43 months (range, 0-36 months). On univariate and multivariate analysis (Tables 6, 7), only silicone tube stents (HR = 3.52; 95% CI, 1.41-8.82; P = .007) (Fig 2) had a significant effect on migration risk. Overall, 12 stents were electively removed without replacement because of a response to therapy. Of these, two had migration. Among the 155 other patients, 25 had migration (P = 1.0). Silicone stents were more likely to be removed electively than metal stents (P = .02).

Granulation Tissue

Thirty-eight granulation events occurred among 195 stent procedures.

Posted on 15 Oct 2014
Critical Care

Respiratory Infections Increase the Risk of Granulation Tissue

Methods: To compare the incidence of complications of different airway stents, we conducted a retrospective cohort study of all patients at our institution who had airway stenting for malignant airway obstruction from January 2005 to August 2010. Patients were excluded if more than one type of stent was in place at the same time. Complications recorded were lower respiratory tract infections, stent migration, granulation tissue, mucus plugging requiring intervention, tumor overgrowth, and stent fracture.

Results: One hundred seventy-two patients with 195 stent procedures were included. Aero stents were associated with an increased risk of infection (hazard ratio [HR] = 1.98; 95% CI, 1.03-3.81; P = . 041). Dumon silicone tube stents had an increased risk of migration (HR = 3.52; 95% CI, 1.41-8.82; P = .007). Silicone stents (HR = 3.32; 95% CI, 1.59-6.93; P = .001) and lower respiratory tract infections (HR = 5.69; 95% CI, 2.60-12.42; P < .001) increased the risk of granulation tissue. Lower respiratory tract infections were associated with decreased survival (HR = 1.57; 95% CI, 1.11-2.21; P = .011).

Conclusions: Significant differences exist among airway stents in terms of infection, migration, and granulation tissue formation. These complications, in turn, are associated with significant morbidity and mortality. Granulation tissue formation develops because of repetitive motion trauma and infection.

Abbreviations: HR = hazard ratio

Central airway obstruction in patients with cancer develops secondary to intraluminal disease, extrinsic tumor compression, or both. For intraluminal obstruction, ablative techniques that destroy tissue are typically used, including laser therapy, electrocautery, and mechanical coring with a rigid bronchoscope, among others. For extrinsic compression, stents are used to strengthen the bronchial wall and provide a barrier against the tumor to keep the airway open. Usually, a multimodality approach is used because findings are often mixed.

Although airway stenting can be a highly effective treatment of central airway obstruction, several complications have been identified. Immediate perioperative complications are rare, but long-term complications are more common and more serious.

Posted on 08 Oct 2014
Critical Care

Immunoassay kit was used to measure 8-isoprostane concentrations in EBC

A specific enzyme immunoassay kit (Cayman Chemical) was used to measure 8-isoprostane concentrations in EBC. Intraassay and interassay variability was ± 5% and 6%, respectively. The detection limit of the assay was 4 pg/mL. The reproducibility of repeated LTB4 and 8-isoprostane measurements was assessed by the Bland-Altman method and by the variation coefficient.

pH Measurement

A stable pH was achieved in all cases after deaeration/ decarbonation of the EBC specimens by bubbling them with argon (350 mL/min) for 10 min, as previously reported. pH then was measured by means of a pH meter (Jenway-350; Jenway; Gransmore Green, UK) with a 0.00 to 14.00 pH range and a mean resolution/accuracy on the order of 0.01 ± 0.02 pH. The reproducibility of the repeated measurements of pH was confirmed by the Bland-Altman test and by the variation coefficient.

Statistical Analysis in Canadian Pharmacy generic viagra

Data were expressed as the mean ± SEM. Mann-Whitney tests were used to compare groups, and correlations between variables were performed using the Spearman rank correlation test. Significance was defined as p < 0.05.

Results

EBC pH

EBC pH was lower in CF children than in healthy control subjects (7.23 ± 0.03 vs 7.85 ± 0.02, respectively; p < 0.0001) [Fig 1, top, A]. The EBC pH of CF patients with an exacerbation was significantly lower than that of stable patients with CF (7.12 ± 0.02 vs 7.31 ± 0.01, respectively; p < 0.0001) [Fig 1, middle, B]. EBC pH was lower in children with asthma compared to healthy control subjects (7.42 ± 0.01 vs 7.85 ± 0.02, respectively; p < 0.0001) [Fig 1, top, A]. A lower pH was observed in children with severe and moderate asthma compared with those with mild asthma (7.36 ± 0.02 vs 7.49 ± 0.01, respectively; p < 0.0005) [Fig 1, bottom, C]. No correlations were observed among exhaled pH, FEV1, and FVC. The reproducibility of EBC pH measurements was assessed in 10 nonsmoking healthy Heatlh Care Viagra Pharmacy adults (six men; mean age, 35 ± 7 years). The mean difference between the two measurements was —0.01 ± 0.4. The coefficient of variation for EBC pH was 0.4% (Fig 2, top, A).

Posted on 08 Aug 2012
Critical Care

Short Advice Helping the Longer Life

A few tips to help seniors at home.

Many people do not realize the complications of the elderly until they reach the age of where even simple tasks become difficult. Things as simple as sweeping the floor or going downstairs become extremely difficult and sometimes impossible. The mere thought of conquering these feats make decisions more critical than they out to be. The worry may be more than anyone is willing to accept.

In this article these are some simple ideas to help the people we love so much have an easier acclimation to an older life. Many of these ideas will not only help your elderly, but they will cut down on your help that they need from you.

Older people often feel they might have a fall or be injured with little or no knowledge or help on the way. The best thing to prevent this from happening is purchasing a medical alert system. A medical alert system help seniors contact paramedics in case of an accident or unforeseen medical emergency. The medical alert system may also contact family members or a close friend. With the simple push of a button the can summoned the help they need. This is terrific for someone living alone. Knowing they can count on someone coming to their rescue is a great release of the stress and worry the elderly may have.

Another problem might be coming up or going down stairs. When examining stairs, try to make it a non-skid surface. If you are going to cover the stairs with carpet, make the carpet a contrasting color from the wall and the floor. That way they can easily see where the stairs are and can identify them at a distance. If they are wooden stairs, you may want to add rubber to each step and the banister. Adding traction to each step prevents slipping. If the elderly person is wearing socks or slippers, it is much easier to conquer stairs without the worry of slipping. You should also add lights to the staircase. In a dark house or at nighttime is when stairs can be most troublesome. Light can help seniors gage the steepness and distance of each step more carefully with a simple light fixture illuminating the walkway.

The kitchen provides some easy remedies. For example, put plates and glasses at a lower level so they are readily available with little effort. Having to reach or strain just to get a plate can cause pain and increase the chance of an injury. It may also be helpful to replace heavy or bulky plates and glasses with smaller, lighter ones. Plastic cups and paper plates are inexpensive and will make carrying them and cleanup very easy.

The laundry room may be equally as challenging. If it is all possible, putting the laundry room on the main floor would prevent having to lug clothes up and down stairs. The likelihood of an accident carrying a basket of clothes, without a banister, into a dark basement is a definite recipe for disaster. Try to make sure the washer and dryer are on the same floor as the bedroom. This makes putting clothes away a much easy and quicker chore.

A product that I was not knowledgeable until recently is a forward lunging chair. It is often difficult for an elderly person to stand up after sitting for a long time. A lunging chair helps them do so by leaning the chair forward while they rise. It provides support and a little push to stand up after sitting down. The chairs are available in many colors and styles and should be a staple of every elderly living room set.

The final suggestions are for the bathroom. A riser for the toilet can usually be purchased from a health supply store. It makes the toilet higher of the ground to make it easier to get on and off. Putting a support bar around the toilet make help an older person leverage their weight as well. A similar bar could be added to the bathtub for the same reason.

Some times the thing we take for granted are the most difficult for seniors. Taking into account their struggles can be fixed with little effort. Most cannot diagnose the problems they may have unless they experience them also. Ask them what problems they may be having because correcting them is often simple. A little help can go a long way.

Posted on 23 Aug 2011
Critical Care

First Aid Courses

First aid courses are available in most reasonably large centres of population. For some jobs it is compulsory for employees to successfully complete a first aid course. These are usually jobs where employees are in regular contact with the public, and may also have some kind of responsibility for their welfare and safety. Of course, it’s also a good idea for everyone to undergo first aid courses as the training may prove to be the difference between life and death in the home someday.

Every year thousands of people die needlessly, because there was no one around at the time who knew basic first aid. There may be plenty of people close by when someone collapses unexpectedly, but if none of the people present knows how to administer first aid, the person could die before the emergency services arrive. It isn’t as if no one wants to help, but rather that they don’t know how to help. It isn’t that basic first aid courses are difficult or costly to get through either. They are not, and it’s a skill that we should all learn, for we will never know when we may be able to save a life.

In the home it’s usually the mother who spends most time alone with the children. If something goes wrong, the mother will naturally deal with the situation immediately and as best she can. But sometimes a child might need immediate assistance, and that’s where a knowledge of basic first aid is vital. Every mother wants to help her child when an accident happens, but without basic training in first aid, they may not be able to administer the necessary help that will save their own child’s life.

That places first aid courses as being something of a priority in the lives of families. The courses usually don’t last very long and they are not difficult to get through, but at the end of the course each participant will know the basics of how to help someone who suddenly collapses, or is involved in an accident when there is no professional medical help immediately available.

Conclusion: First aid courses are run regularly in most towns and cities, depending on demand, and they can and do save lives. Every day, somewhere on our network of roads and motorways, there are accidents. Many of them are not overly serious, but the people involved often do need immediate treatment. You could be the first person to arrive on the scene of an accident, and if you don’t know how to administer basic first aid, lives could be lost. First aid courses can save lives.

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Posted on 14 Jul 2011
Critical Care

Doctors Are Steering Away From Prescription Medications

Many times a visit to the medical doctor just results in a wait and see. As you leave that medical doctor’s office without a prescription you may feel better having been seen however if your doctor has said contact us next week if it still hasn’t cleared up and have instructed you to take over the counter medications and use topical solutions to get rid of the symptoms you’re experiencing then this is a definite sign that you came to the doctor too soon.

Of course, when you are coping with a life threatening health issue you must rush to the medical professional for treatment and when it comes to severely high fevers, vomiting that lasts for an extended period, dehydrations, or difficulty breathing well then you need to head to the local emergency room at once. For those troubles such as cuts and abrasions, bumps and bruises, sprains and strains, and even skin rashes there are very few things that a physician can do other than monitor the situation and watch for it to get any better or worse.

Several physicians have gotten away from making use of prescription drugs and antibiotics as methods for the treatment of health related issues unless they are necessary and many medical professionals do not want to prescribe steroids and such except if they have to. As far as allergies go, when they involve skin rashes they could typically be addressed by over the counter allergy medications and topical creams and ointments as well. Sometimes a prescription will be in order however, these days the medical profession has made a lot of prescription medications available over the counter to aid people in treating themselves from home.

Of course, self-treatment is only recommended when you really know what you are dealing with and from time to time you can look up various symptoms on the internet to help you unearth what the health issue may be as well as the various ways to identify and treat the condition. Many times you are unable to only uncover the conventional ways to treat a medical issue or illness but you can also find a variety of home and herbal options for treatment as well.

Ultimately, as long as the patient’s life isn’t in danger then it is best to take a wait and see attitude with health issues. Amazingly the human body is pretty intelligent and therefore it begins working on the issue many times before you even know there is a problem. It is a smart system and for the most part one that can take you from sickness to health without significant intervention.

Posted on 26 May 2011
Critical Care

Basic ECG Interpretation For Beginning Nursing Students

If you are a budding nursing student and are looking for ways to understand the all important ECG simulators, either because you are preparing for your nursing exam, or because you just want a refresher so to brush up on reading the ECG printouts in the hospital setting, then you will want to go over this information.

Or, perhaps you are a nursing technician who is reading the ECG printouts in your daily job testing patient monitors with ECG simulators. You will find here a simple explanation of the basic ECG patterns which will constitute a baseline with which all the more complicated arrhytmic heart patterns will be compared.

In this article, we will explain the ECG, electrocardiogram, signal in the simplest possible terms. This should help you establish a baseline for your more comprehensive study.

First, consider the flow of blood through the heart sections

For the purpose of the explanation of the cardiogram, let’s first establish the naming: Atrium is the upper part of the heart, Ventricle is the lower, bigger part of the heart. Between them, there is a heart valve which is designed to open in the direction of the blood flow. The blood always flows in the direction from the atrium to the ventricle. The valve design prevents the blood from flowing in the opposite direction.

The flow of electric impulses follows the flow of blood

The electric impulses that regulate the contractions of the heart have their own pathway from their origin in the “sinus” section of the top of the wall of the atrium. Starting in the atrium, the initial signal will cause the contraction of the atrium. From there, the electric signal lines go through the dividing region between the atrium and the ventricle (the AV region), where the signals get significantly delayed in time. Then, they move through the walls of ventricle where they finally cause the contraction of the ventricle.

The ECG signal mimics the flow of the electric impulse through the walls of the heart

The normal ECG signal is composed of the phases P, QRS, and T. The ECG signal in time follows the electric signal passing from the “sinus” section of the atrium, through the atrium, the AV section, and finally to the ventricle. So, the sequence of the repeating pulses you will see in the electrocardiogram printout will be as follows: P phase which takes about 0.1s is a small pulse representing atrial depolarization which is associated with atrium contraction. After a delay, the next phase is

QRS complex phase take about 0.1s is a large pulse representing ventricular depolarization which is associated with ventricular contraction. The phases Q and S are actually slightly negative, while the phase R is strong and positive. Incidentally, as the valve closes, the atrial repolarization takes place which is associated with atrium expansion. This, however, is hidden due to the size of the ventricular depolarization signal.

Finally, the last phase is

T phase which represents ventricular repolarization, corresponding to the slower expansion of the ventricle.
The entire process then normally repeats itself. This is the basic normal heart beat ECG signal, in a nutshell. ECG interpretation made easy.

Posted on 04 May 2011
Critical Care

Tips For A Safe Hospital Stay

Being admitted to the hospital is intimidating and scary. Today’s hospital patients are sicker and more medically compromised than every before. Once they are in the hospital patients feel very vulnerable, exposed (sometimes literally) and generally not in control. But, there are steps you and your loved ones can take to gain a sense of control and ensure a safe hospital stay.

Be part of the quality solution. If you have concerns about the quality of care you received while a patient in the hospital call the Quality Improvement Organization in your state. Call 1-800-633-4227 to get your state specific number.

Follow These Ten Tips To Ensure A Safe Hospital Stay

1. Insist on clean hands to prevent the spread of infection. This goes for all the medical staff as well as family and visitors. If you don’t see someone wash their hands or use an alcohol-based solution, politely ask them.

2. Help prevent medication mix-ups by insisting that staff check your wristband each time they give you a drug, draw a blood sample or perform a test. Ensure that the information on your wristband is accurate especially if you have any drug allergies.

3. If a medication looks different than you expect, ask the nurse to double-check it.

4. Understand why a test or procedure is being performed. Every study or lab test is performed to answer a specific question. Ask is there are alternatives.

5. Don’ get out of bed without help unless you are told you can. New medications can make you feel fine lying down, but can make you less stable on your feet.

6. Write down questions as they occur to you, and then ask your nurse or physician for answers. At discharge be sure to get clear instructions on what you should and should not do.

7. Tell your caregivers about all medications you take at home, including supplements and over-the-counter medications. If possible compile a drug list of current medications and dosages to be placed in your chart.

8. Prepare a living will. Make sure this is in your record. Appoint a health-care proxy to make sure doctors follow your wishes if you are incapacitated and issues arise that are not in your living will.

9. If possible, appoint your own advocate to stay at your bedside during your stay. This individual can serve as another set of eyes and ears when receiving information from healthcare professionals and can also be alert to any deviation in care that might adversely affect the patient (food being given to a patient who is not supposed to have anything by mouth prior to surgery, ensuring staff wash their hands, etc.)

10. If something doesn’t’ seem right, tell your nurse or physician. If your concerns are still not addressed request to speak to the charge nurse or the hospitals patient advocate.

Hospitals normally run in a well-choreographed manner with many professionals all performing at their best. Keeping these tips in mind will help to ensure the safety of any future hospital visits.

Posted on 06 Feb 2011
Critical Care

Emergency Ward in the Hospital

If you find someone falling ill suddenly or you have to rush an accident victim to the hospital, you always approach the emergency ward in the hospital, where doctors and staff are always available to immediately tend to the patient, administer the emergency treatment and stabilize them before sending them out to the other specific wards for further treatment. The emergency room is always equipped with necessary equipment and infrastructure to meet all emergencies.

As the nature of the patients coming into the emergency ward is always of critical and urgent nature, the staff, nurses as well as the doctors in this ward are trained to respond to such emergency situations. They are sensitized to looking and providing immediate treatment to the patients to get situation under control and stabilize the vital signs in patients as well as deal with injuries and other problems which need immediate response.

Any hospital’s reputation is dependant upon its ability to provide right and proper treatments to the patients at the right time. Especially in case of emergency ward, it becomes all the more important to have the right expertise and ensure that the patients get immediate response.

If you think that medical training runs on the similar likes to other professions, you are mistaken. It is the doctor’s in whose hand many a people’s fate lies between life and death. Hence doctors cannot afford to make mistakes. There is no chance for error in medical practice. Therefore the medical training adapts very high standards.

The life and fate of the individuals in totally in the hands of the doctors who cannot afford to make any slight mistake. Any consequential damage to the patient rendering him incapacitated can mean huge damage to the family too. They might stand to loose the only earning member of the family and besides face emotional trauma too.

There is a lot of difference between the procedures and treatments between other specific wards to the emergency wards. When in case of emergency the patients require immediate attention and instantaneous response from the doctors to stabilize the arrest the damage to the patient’s system before he is taken to the other wards for treatment. Hence the hospital emergency ward would need to always be in a ready mode at all times.

The efficiency and the infrastructure of the emergency ward of any hospital reflect the philosophy and focus of the management as well as administration of the hospital.

Depending upon the treatment one receives at the emergency ward, you can estimate the kind of response and treatment you are likely to get in the rest of the wards in the hospital.