Epidemiology, Assessment, And Presentation Of An Elderly...

Epidemiology, Assessment, and Presentation of an Elderly...
As technology advances and medical aid becomes readily available it is no wonder that the elderly
within our communities are living longer. Unfortunately this poses a serious issue for health
professionals as elderly are becoming more prevalently injured, presenting with complications of
higher severity than their younger counterparts (Ng et al., 2002). This essay will discuss the
epidemiology, assessment and presentation of an elderly patient suffering from a traumatic injury. It
will also examine the considerations specific to the elderly in terms of management, and ethical and
cultural differences. As we grow older our susceptibility to a traumatic incident increases
dramatically (Chan, Moran, Clarke, Martin, & Solomon, 2009). Elderly ... Show more content on
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Also their ability to compensate is short lived, with each year increase in age from 65 years resulting
is a 6% increase in likelihood of death from injury (O'Neill, Brady, Kerssens, & Parks, 2012). When
it comes to the elderly patient there are three particular challenges that all health professionals
should take into consideration; co–morbidities, polypharmacy and blunted compensatory
mechanisms (PHTLS, 2011). Co–morbidities are important to consider as an existing medical
condition may alter the vital signs you measure. Polypharmacy is particularly important especially if
the medications the patient is on could render them unable to compensate appropriately or if you
need to administer other medication/fluids. Lastly and possibly most important in trauma is blunted
compensatory mechanisms. The elderly are unable to compensate in the way adults are able to
which makes them vulnerable when injured (PHTLS, 2011). They do not react the way in which you
would expect, meaning you should take extra care when dealing the elderly as their condition can be
extremely unpredictable. Any trauma incident begins with an assessment of the scene and
determination of the degree of severity of the situation at hand. In RTC this is of great importance as
the higher the speed the vehicles were travelling at, the worse condition the patient could be in.
Upon greeting the patient it is important to put them at ease and explain your assessment as you go.
It is common
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Pediatric Nursing Study Guide -- Covering Communicable...
Concept Test Map/Study Guide
Test 2 will include chapters 36, 38, 49, 50, 53
To prepare for Test 2 please review the following:
Communicable diseases (CH38) April 2 a. Stages * Invasion of organism * Incubation period *
Prodromal period * Clinical manifestations (S/S) * Convalescent period * Return to wellness b.
Immunities * Active immunity naturally acquired – already exposed * Active immunity artificially
acquired – vaccination * Passive immunity naturally acquired – * Passive immunity artificially
acquired –– c. Childhood communicable diseases
Viral Exanthems (w/ rashes) ... Show more content on Helpwriting.net ...
* Vitamin A * Supportive * Bed rest during febrile period; antipyretics * Antibiotics to prevent
secondary bacterial infection in high risk children * Complications * Otitis media * Pneumonia
(bacterial) * Obstructive laryngitis and laryngotracheitis * Encephalitis (rare but has high
moretality) * Nursing care/Management * Isolate until 5th day of rash; Droplet precautions *
Encourage rest during prodromal stage; quiet activity * Fever– instruct parents to admin
antipyretics; avoid chilling; seizure precautions * Eye care– Dim lightds in photophobia present;
clean eyelids w warm saline to remove secretions/crusts; keep child from rubbing eyes * Coryza,
cough– Use cool mist vaporizer; protect skin around nares with layer of petrolatum; encourage
fluids and soft, bland foods * Skin care– Keep skin clean; use tepid baths as necessary * Varicella ––
(2–8 yr of age) pg 1058 and notes (Ch 38) * Agent: Virus – Varicella zoster virus (VZV) * Source:
NP secretions, vesicles (fluid filled/elevated) – Primary secretions of respiratory tract of infected
persons; to a lesser degree, skin lesions ( scabs not infectious) * Incubation: 2–3 weeks – usually
14–16 days * Communicable: 1day before rash (prodromal period) to 6 days after first crop of
vesicles when crusts have formed AKA 1 day before to 6 days after rash * Transmission:
direct/indirect/airborne

Morbid Obesity And Its Effects
Introduction :
Morbid obesity represents a great challenge to the operating room team due to dangers of inducing
general anesthesia with life threatening complications including airway obstruction ,rapid
desaturation and aspiration.(1) Morbid obesity may be associated with obstructive sleep apnea and
large neck circumference with difficult intubation (2)
Difficult airway is the clinical situation in which a trained anesthesiologist experiences difficulty
with face mask ventilation, tracheal intubation or both.(3)
The use of fibreoptic bronchoscope for difficult tracheal intubation has been gradually increased.
Anesthesiologists still have limited skills with awake fibreoptic intubation. (4,5)
The learning curve for intubation using the fiberoptic bronchoscope must be always developed in
patients with normal airway and considered succeeded after at least 10 successful single attempt in
less than 2 minute(6,7)
Airtraq TM optical laryngoscope, is a device for routine and difficult intubation. It has a curved
blade with 2 side by side channels for endotracheal tube and optical system. This device affords
good illumination view of the glottis with no more force applied and with no need for alignment of
the oral, pharyngeal and laryngeal axes. Awake intubation with Airtraq TM can be a reasonable
choice for patients with difficult airway.(8)
Fig 1: Airtraq TM laryngoscope
In this study we evaluated the difference between awake intubation using either the fiberoptic

Airway Assesment Of The Difficult Airway Before Manipulation
CHAPTER III
AIRWAY ASSESMENT IN TRAUMA PATIENTS Identification of the difficult airway before
manipulation is the Holy Grail of clinical management. It is the first step in preparing for patient
care. Selection of airway devices, techniques, and procedures all pivot on airway evaluation (Carin,
2008). Preoperative examination of the airway is essential. Identification of patients with a
potentially difficult airway before anesthesia allows time to plan an appropriate anesthetic
technique. Previous anesthetic records should always be consulted. However, a past record of
normal tracheal intubation is no guarantee against difficulty on subsequent occasions as airway
anatomy can be altered as in trauma affecting the airway. The presence of stridor or hoarse voice is
warning sign for the anesthetist. As it is impossible to identify all patients with a difficult airway
during preoperative assessment, the anesthetist must be prepared to manage the unexpected difficult
laryngoscopy (Alan et al,. 2001).
 Historical Indicators of Airway Difficulty: The intent of obtaining an airway history is to elicit
previously known factors indicating that airway management has been (and likely will be) difficult.
Any patient who is awake and capable of coherent conversation should be asked about prior
intubation and ventilation successes or failures. Some patients possess a Medic Alert bracelet
indicating a history of difficult intubation or ventilation and this can be useful in obtunded

Activities of Living-Case Study
Throughout this essay, the chosen nursing model of assessing a patient's social needs and medical
history; Roper, Logan and Tierney (R–L–T model) Activities of living (AL) will be outlined
(Holland et al, 2008). Through the use of substantial and relevant theoretical literature, AL will be
highlighted i.e. biological, psychological, political economic, environmental and social–cultural
issues. This will include theoretical highlights of care given to a patient admitted in hospital
holistically. Basically by assessing and examining the importance of model and framework in
nursing practice will help to understand the patient and rationale. A framework of Assessment,
Diagnosis, Planning, Implementation and Evaluation (A. D. P.I.E) will be ... Show more content on
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The lifespan situations and objectives are agreed between nurses and patients. Finally, assessment
and nursing process is used regardless of the patient's state of health (Holland et al, 2008).
Negatively, to systematic approach provided to patients. R–L–T model focuses on patient's disease–
centred approach rather than their strengths and potentials. It makes patients loose independency and
become dependent on nurses. I think meeting targets may be jeopardised because AL are like a
questionnaire and patients answer promptly. As Tierney, 1998 (cited in Pearson et al, 2005¹¹)
stressed that it might be seen as inflexible and stereotyping as nurses focus on health rather than
illness. Similarly, R–L–T model uses important AL of patients to suit appropriate care rather than a
complete holistic care approach (Pearson et al, 2005¹¹) In addition, patients are involved more in the
model not in its uses, obstructing more time to focus on current issues. I noticed that, R–L–T model
has a large impact on first assessment than acting as a continuing process. Capra, 1982 (cited in
Pearson et al, 2005¹¹) made a point that nurses' main duties and time were spend on healing process,
but patient contact not acknowledged and is diminished. Finally, the model expects the patient's
biological aspect of health to recover and other factors will be met (Aggleton, 2000). Chosen Patient
and Rationale Mr Hussein, 57 years old,

Fistula Lab Report
The surgical procedure that I observed was the creation of an arteriovenous fistula. The purpose of
an arteriovenous fistula is to make a connection between the native artery and vein in an extremity
through surgery. The surgical procedure that I saw performed, which was done by a vascular
surgeon, was an AV fistula on the upper right arm. These fistulas are used for hemodialysis and
accessed/used for dialysis 2–5 times per week. Basically, the vascular surgeon creates this fistula so
as to provide easier/more reliable access to the patient's blood vessels. Fistulas provide vascular
access for health care providers to be able to administer dialysis in a much faster and safer way. The
AV fistula takes about 2–3 weeks to mature before it can be used for hemodialysis. The surgeon
chose an arteriovenous fistula over an arteriovenous graft. The ... Show more content on
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The surgical technician worked closely with the surgeon to pass him the correct surgical tools and
pass him anything he would need should they be out of his reach or if a complication arose. She
prepared and pre–counted all of the tools including any type of gauze that would need to be
accounted for at the end of the procedure to avoid leaving any tools inside the patient. The
circulating nurse's job was to monitor vital signs to make sure the patient is stable during the
procedure, keep track of surgical tools, and provide the surgical technician/surgeon any tools they
may need. The circulating nurse also charted all of the information about the patient such the start
and end time of the procedure, what position the patient was in, the patient's vital signs, the side of
the patient the procedure would be on and what procedure was being done. The circulating nurse
also initiated the time out, wherein all members of the surgical team time out and verify that they
have the correct patient, correct procedure and site of

History Of Present Illness : 34 Year Old Woman With A...
History of present illness: 34–year–old woman with a history of Wolff Parkinson White Syndrome
complains of intermittent palpitations since 2005. She has had a 24–hour Holter, which was
unremarkable. She came in for a follow–up visit and had an EKG done that revealed the presence of
pre–excitation. The patient reports a daily sensation of palpitations that lasts for several minutes.
The patient reports lightheadedness with the palpitations without syncope. The patient underwent an
exercise treadmill evaluation, which showed no evidence of ischemia. The echocardiography
revealed a structurally normal heart. Delta waves were noted during evaluation but resolved at
higher heart rates. Wolff–Parkinson–White syndrome (WPW) is a conduction disorder of the heart
that is caused by pre accessory pathway resulting in tachyarrhythmias. Kesler & Lahham (2016)
state, "Approximately 0.07% of the population often presents with the chief complaint of
palpitations". A diagnosis of WPW is made in conjunction with certain characteristics.
Characteristics of WPW include: a short PR interval < 0.12 second caused by a faster electrical
conduction through the accessory pathway than the atrioventricular node, upsloping of the QRS and
a delta wave. The delta wave is indicative of rapid ventricular depolarization caused by the rapid
conduction through the accessory pathway (Kesler & Lahham, 2016, p. 469).
CEBM, Level 4
Past Medical History: In addition to her current condition the patient has a

A Brief And Procedural Duties Of A Resident Medical Officer
Having completed almost eighteen months working as a competent resident in a variety of settings, I
am confident I can continue to undertake clinical and procedural duties of a Resident Medical
Officer (RMO) in 2017. During my terms as an intern and RMO, I have demonstrated exceptional
clinical experience that is required for a successful junior doctor working as a resident or registrar.
During these terms I had many opportunities to complete patient admissions. I would correctly
identify a new medical patient that requires admission and commence my clinical work up. This
process entailed taking thorough but time efficient histories, performing examinations, problem list
formulations, creating differential lists, ordering investigations, requesting consultations and
generating management plans. I was often commended for my efforts in obtaining comprehensive
histories with a detail management plan while also being aware of time constraints. On my
respiratory term, I often enjoyed working closely with my registrar on the consults team. Our role
was to review referrals from ED, AMU and the wards to either take over care or provide
management advice. During this particular day, my registrar was required to attend meetings and so
I took the initiative to review the referrals. Within the space of 30 minutes I reviewed, assessed and
created recommendations for an AMU patient which I then presented to my team. My consultant
and registrar agreed with my recommendations while also

Obesity Is An Increasing Problem All Over The World And...
Obesity is an increasing problem all over the world and its prevalence differs from one area to
another. According to World health Organization (WHO) obesity is defined as body mass index
(BMI) of 30kg/m2 or more.1
It was reported that the proportion of obesity in surgical patients is greater than general population.2
This means that anesthesiologists are going to deal with increased number of obese patients whose
airway management is one of their own responsibilities. Endotracheal intubation is more difficult in
obese than in lean patients.3 Difficult tracheal intubation is defined by the American Society of
Anesthesiologists (ASA) as tracheal intubation requiring multiple attempts in the presence or
absence of tracheal pathology.4 1 Failure of tracheal intubation is one of the major causes of
morbidity and mortality during anesthesia.5,6
Consequently, the use of new tools that increase the success of tracheal intubation, particularly in
settings of potentially difficult intubation, can have a profound clinical impact.
The LMA CTrach® is a modified intubating laryngeal mask airway, which incorporates an inbuilt
integrated fibreoptic system and a detachable battery powered LCD colour monitor with a light
source that enables visualization of glottis during intubation.7
King vision is a new portable battery powered video laryngoscope that is composed of reusable
monitor and disposable blade which may be channeled or non–channeled. It is used successfully for
tracheal

The Routine Use Of Endotracheal Tube
It has been established that inability to successfully manage very difficult airway was been
responsible for as many as 30% of death totally attributable to anesthesia. (1)
The routine use of endotracheal tube is to secure the airway and prevent the aspiration of gastric
content in case of regurge or vomiting but there is a case series demonstrated that the routine use of
the endotracheal tube did not reduce maternal death due to aspiration(2)
Supraglottic airway devices have become a standard in airway management. These devices sit
outside trachea but provide a hands free means of achieving a gas tight airway(3). The i–gel is
supraglottic airway devices. The soft non inflatable cuff fits snugly on to the perilaryngeal frame
work, mirroring the shape of the epiglottis, aeryepiglottic folds, piriform fossae, perithyroid,
pericricoid, posterior cartilages and spaces. The seal created is sufficient for both spontaneously
breathing patients and for intermittent positive pressure ventilation. it provides a better seal for
positive pressure ventilation, separation of the respiratory from the alimentary tract.(4) The drain
tube prevents gastric insufflations, allows easy placement of gastric tube it has been shown that the
i–gel airway is better alternative device compared to PLMA for ease of insertion and maintenance of
anesthesia. (3,4) The i–gel works in harmony with the patient's anatomy so that compression and
displacement trauma are significantly reduced or

The Effect Of Closedendotracheal Suctioning Systems On...
1. Inan D, Saba R, Yalcin A, Yilmaz M, Ongut G, Ramazanoglu A and Mamikoglu L.
Deviceassociatednosocomial infection rates in Turkish medical–surgical intensive care units. Infect
ControlHospEpidemiol. 2006 Apr; 27(4): 343–8.
2. Caramez M, Schettino G, Suchodolski K, Nishida T, Harris R, Malhotra A andKacmarek R.
Theimpact of endotracheal suctioning on gas exchange and hemodynamics during lung–
protectiveventilation in acute respiratory distress syndrome. Respir Care. 2006 May; 51(5): 497–
502.
3. Taylor C, Lillis C and LeMone P. Fundamentals of nursing. Philadelphia: Lippincott Williams
&Wilkins,7th ed.2010
4. Phipps W, Monahan F, Sands J, Marek J and Neighbors M. Medical–surgical nursing: Health
andillness perspectives. St. Louis: MO: Mosby,8thed; 2011.
5. El Masry A, Williams P, Chipman D, Kratohvil J andKacmarek R. The impact of
closedendotracheal suctioning systems on mechanical ventilator performance. Respir Care. 2005
Mar; 50(3):345–53.
6. Kozier B, Erb G, Berman A and Snyder S. Fundamentals of nursing: concepts process and
practice New Jersey: Pearson Prentice,10thed; 2015.
7. Bourgault A, Brown C, Hains S and Parlow J. Effects of endotracheal tube suctioning onarterial
oxygen tension and heart rate variability. Biol Res Nurs. 2006 Apr; 7(4): 268–78.
8. Lee E, Kim S and Kim J. Effects of a closed endotracheal suction system on oxygen
saturation,ventilator–associated pneumonia, and nursing efficacy. TaehanKanhoHakhoe Chi. 2004
Dec; 34(7):1315–25.
9. Ongerden I,

Patients And Methods Of The Department Of Anesthesia
PATIENTS AND METHODS
This study was approved by the Ethics and Research
Committee of the Department of Anesthesia, and written informed consent was obtained from all the
study participants attending the Cardiothoracic Surgery Department.
A total of 55 patients underwent cardiac surgery involving cardiopulmonary bypass (CPB), 45 (40–
55) years were screened from January 2008 to December
2009 and 49 were enrolled in the study based on the following inclusion criteria: Patients were
American
Society of Anesthesiologists physical status II, ejection fraction (EF) ≥40% and scheduled for
elective cardiac surgery under general anesthesia. No difficulties with their airway management or
intubation were predicted during preoperative visits according to Mallampati score classification.
Exclusion criteria were patients undergoing emergency surgery or those allergic to any of the drugs
in the protocol, a history of reactive airway disease, gastroesophageal reflux, morbid obesity, heavy
smoker, alcohol or opium addiction, which could be increase fentanyl use during the study due to
increase tolerance.
A total of six such cases were excluded from the study.
The patients taking their medications before surgery had similar protocol. All of them were taking
metoprolol, nitrocontin, and aspirin [Table 1]. The patients were randomly allocated into the
following two groups by the sealed envelopes method, the I–gel group and ETT group, on the
airway management.
Peripheral arterial and venous

Advanced Care Paramedic (ACP)
A recently graduated working paramedic is referred to as an Advanced Care Paramedic, or an ACP.
An ACP follows a clinical structure, the first aspect of the format is called a primary survey which
collects all emergency patient information. This compulsory technique aims to identify and control
catastrophic medical events to ensure patients have the best outcome possible (Hodegetts et al.,
2011). When conducting a primary survey of a patient an ACP would follow the basic structure of
danger, response, airway, breathing and circulation; usually shortened into the acronym DRABC
(Woo, 2000).
To begin the primary survey, DRABC should be started as soon as possible (QAS reference). It is
crucial for effective, emergency response to patients suffering ... Show more content on
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Thus Paramedics Australasia devised an introduction to the clinical role of a paramedic, although
slight variations in differing jurisdictions. Under Paramedics Australasia a paramedic is a health
professional that provides emergency medical treatment and assessment, rapid patient response in an
out–of–hospital setting (Paramedics.org, 2016) It is important for paramedics not to exceed their
scope of practice as the patient outcome is significantly decreased, a multidisciplinary view on the
care being provided is negatively affected which in turn ensures non–informed decisions are being
made for the patient unknowingly (Paramedics.org, 2011). If a graduated paramedic exceeds their
scope of practice, patient outcomes become substandard to the care they could provide within their
scope of practise (Fitzgerald,

The Importance Of Effective Communication Within A Team...
This case study will focus on a case where the care provided to the patient had to be changed to
meet altered patient requirements and the importance of effective communication within a team and
how this was accomplished. Gibbs reflective cycle (1988) will be used to evaluate practice and the
outcomes, whilst adhering to Local trust policies (2015) and NICE guidelines (2012).
Confidentiality will be maintained in accordance with Health and Care Professions Council (HCPC,
2012).
This case study will follow a gentleman on the dental list for the extraction of his lower left wisdom
tooth. Before the operating session began the whole team participated in a team brief as part of the
World Health Organisation (WHO, 2009) and in line with local trust policy (2015), to discuss the
care and requirements for each patient on the days operating list. There were no concerns or special
requirements highlighted for this patient. Dental surgery ****
The patient arrived in the anaesthetic room with a health care assistant (HCA), he was an elderly
gentleman with a BMI of 35 ====handover. Once he was settled on the trolley all the routine
checks (like ) of his consent forms and care plan were completed and confirmed by both the patient
and the anaesthetist prior to starting the anaesthetic, to ensure his details were correct. In accordance
with The Association of Anaesthetics of Great Britain and Ireland (AAGBI, 2007) guidelines, the
patient was connected to the required monitoring, this

Buergers Dse
BUERGER'S DISEASE A nursing case study Presented by: Group 26 Charlotte faith Valeroso
Barbie Joy Tumaliuan Chramaigne Tumaru Rovierose Sotelo Leslie Agngarayngay Grace Tabanda
Rohmar jones Tingonong Caroline D. UY Submitted to: Ms. Divina L. Malana, RN, MSN
INTRODUCTION Buerger's disease is thrombotic and inflammatory occlusion of small arteries and
veins among smokers. It is also known as ThromboangiitisObliterans. It involves inflammation and
fibrosis of nerves. It results in thrombus formation and segmental occlusion of the vessels. It is
differentiated from other vessel diseases by its microscopic appearance. In contrast to
atherosclerosis, Buerger'sdisease is believed to be an autoimmune vasculitis that results ... Show
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It is important to know and understand its clinical manifestation in order to help the patient manage
such. For the Presenters: This will study will provide an opportunity for the presenters to really
know the disease that significantly affects anybody. It will also give them an avenue to show how
much they have understood about the disease and how much are they able to share effectively to
their fellow student nurses – the simplest and the best way that they could. For the Audience: This
study will significantly give essential insights and raise awareness among the members of the
audience. Their wrong notions about the disease will be rectified via the case presentation For the
Clinical Instructors: This study will provide a venue for the clinical instructors to gauge learning
competence of the level three students on medical–surgical nursing concepts taught during the
previous semester. It will also provide them the opportunity to give supplements and/or updates not
known to the case presenters. OBJECTIVES General: The very objective of this case study is for the
students to have an in–depth understanding of Buerger's Disease – its manifestations and
management – and its prevention. Specific: Towards the end of the case presentation, the following
shall have been achieved: 1. Increased knowledge and understanding of the disease among the
student

The Importance Of A Patient Through The Anaesthetic Role...
Introduction
This Anaesthetic case study would describes and discussed the scenario of a patient through the
anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety
procedures equipment and drug interventions used to ensure this particular patients maximum safety
and comfort before and during the procedure. The case study will include pre and peri–operative
assessment in order to describe the involvement contribution of various specialties in the holistic
care of the critical care patient. This assignment will focus only on the anaesthetics side of the
procedure but will also highlight the importance of the triad of anaesthesia and discuss the
administration, maintenance and reversal of ... Show more content on Helpwriting.net ...
The appropriate assessment of patients prior to surgery to identify coexisting medical problems and
to plan peri–operative care is of increasing importance. The goals of peri–operative assessment are
to identify important medical issues in order to optimise their treatment, inform the patient of the
risks associated with surgery, and ensure care is provided in an appropriate environment secondly to
identify important social issues which may have a bearing on the planned procedure and the
recovery period and to familiarise the patient with the planned procedure and the hospital processes.
(American Society of Anaesthesiologists)
Clearly the peri–operative evaluation should include a careful history and physical examination,
together with structured questions related to the planned procedure. Simple questions related to
exercise tolerance (such as can you climb a flight of stairs without shortness of breath) will often
yield as much useful information as complex tests of cardiorespiratory reserve. The clinical
evaluation will be coupled with a number of blood and radiological tests to complete the clinical
evaluation. There is considerable debate as to the value of many of the routine tests performed, and

Essay about Case Study
1. Table 8.1 shows results of an eight–center clinical trial to compare a drug to placebo for curing an
infection. At each center, subjects were randomly assigned to two groups. Table 8.1 Clinical Trial
Data for Problem 1 a. Perform two different tests (Breslow–Day, and likelihood ratio test) for
whether the drug effect on curing an infection is the same over eight centers. i) Breslow–Day test:
The B–D test of homogeneity tests for whether the drug effect on curing an infection is the same
over eight centers gave a chi2 = 8.0 with df=7 and p–value = 0.333. Therefore since the p–value is
> 0.05, we fail to reject the null that the drug effect on curing an infection is the same over the
eight centers. The drug effect ... Show more content on Helpwriting.net ...
What is your conclusion with regard to the effect of the drug on curing the infection? What is the
odds ratio using the CMH method? The OR for curing the infection comparing drug with placebo,
adjusting for the centers is 2.175, with a p–value of 0.011 which is less than 0.05 and therefore
significant. We can conclude that the drug is 2.175 times better at curing the infections after
adjusting for centers compared to the placebo. Using the CHM Method: From the CMH method
above, the combined OR=2.13, with a p–value of 0.0115 which is significant at the 0.05 level.
Therefore the drug is 2.13 times more effective at curing the infection after adjusting for centers
compared to the placebo d. Perform a new logistic regression to find the odds ratio for curing the
infection without adjusting for the centers. Which measure, adjusted, or unadjusted odds ratio, do
you prefer to use when you investigate the drug effect on curing the infection? From the output
above, the OR without adjusting for centers is 1.5 with a p–value of 0.108 which is not significant at
the 0.05 level. Therefore, I will prefer to use the adjusted measure when investigating the drug effect
on curing the infection. e. (Extra Credit) Perform a likelihood ratio test on whether the treatment is
different among the centers, using the deviance measure. data medtreatment; input center drug
treatment count; datalines; 1 1 1 11 1 1 0 25 1 0 1 10 1 0 0 27 2 1 1 16 2 1 0 4

Idiopathic Interstitial Pulmonary Firosis ( Ipf ) Essay
Idiopathic interstitial pulmonary firosis (IPF) is considered the most common form of interstitial
lung disease (ILD). Its course is a progressive of and its cause is unknown. Idiopathic interstitial
pulmonary firosis a‫ٶ‬ect the gas exchange as it results in chronic inflmmation and progressive firosis
of lung parenchyma. Нe signs and symptoms of this disease consist of progressive dyspnea,
hypoxia, clubbing and crepitations at the lung bases [1]. IPF is a fatal lung disease; the natural
history is variable and unpredictable: Most patients with IPF demonstrate a gradual worsening of
lung function over years; a minority of patients remains stable or declines rapidly. Some patients
may experience episodes of acute respiratory worsening despite previous stability. НH
ATS/ERS/JRS/ALAT 2011 Revised Diagnostic Criteria Нe diagnosis of IPF is based on the absence
of a known cause of lung firosis computed tomography (CT) fidings and, in cases with CT
abnormalities that are not classical for IPF, the use of pathological criteria [2]. An 2‫ٹ‬FLDO
ATS/ERS/JRS/ALAT Statement IPF is defied as a specifi form of chronic, progressive firosing
interstitial pneumonia of unknown cause, occurring primarily in older adults, limited to the lungs,
and associated with the histopathologic and/or radiologic pattern of unspecifid interstitial
pneumonia (UIP) [3]. НH Diagnosis of IPF Requires 1. Exclusion of other known causes of
interstitial lung disease (ILD) Нe presence of a unspecifid interstitial

Mask Ventilation Essay
Although ventilation is not usually provided during the apnoeic period, some anaesthetists will give
a single breath, or several gentle breaths, to both confirm that mask ventilation is possible and
reduce the development of hypercapnia, acidaemia, and hypoxia. Some guidelines advocate use of
mask ventilation for this reason in patients at elevated risk of hypoxia, for example, the pregnant
patient.4,5 Apnoeic oxygenation is increasingly used, especially in critically unwell patients, to
provide an oxygen–rich environment in the oropharynx to minimise hypoxia during the apnoeic
period of RSI.6 This is provided by an alternative oxygen source, commonly via nasal prongs with
oxygen flow at 10 litres per minute or more, or via insertion of ... Show more content on
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This pressure is maintained until endotracheal tube placement is confirmed. The rationale is that the
upper oesophagus is occluded by being compressed between the trachea and the cervical vertebrae,
preventing passive reflux of gastric contents.
Cricoid pressure should be released if laryngoscopy is difficult, or if vomiting occurs (to reduce the
chance of oesophageal rupture from active vomiting). Suspected or known laryngeal or unstable
cervical spine injury contraindicates use of cricoid pressure.
Controversy around cricoid pressure
Although routinely performed in many parts of the world – particularly the United Kingdom, North
America, and Australia – cricoid pressure is contentious. It is not common practice in Europe, and
some pre–hospital organisations do not endorse its use.
Concerns include:
reduced quality of laryngoscopy,
lack of evidence of effectiveness in preventing reflux and aspiration,
reduced lower oesophageal sphincter tone and therefore increasing reflux

Research Paper On Emergency Nursing
Drug administration is a fundamental part of every day in nursing profession. No medication is
completely safe and protected in this manner. Therefore, nurses need to have an intensive and broad
knowledge of the medications and its method of organization in the compelling treatment of patients
whose life lies in her grasp (Satoskar, Bhandarkar, 2005)
Emergency Nursing is a special type of nursing in which nursing staff look after patients in the crisis
or basic period of their disease. In conventional routine of nursing, a patient lands with an analysis
connected by a doctor and the staff nurse, must deal with the patient's consideration as per that
finding, where as in emergency nursing, obligations of a nurse as a medical caretaker are different
because diagnosis has not yet been made and the reason for the issue is unknown. In this
circumstance, the nurse must ... Show more content on Helpwriting.net ...
It was developed for the ready for situations that require quick actions with no waiting, how to
recover the awareness or to restore the vital signs of patient like pulse rate, blood pressure, etc.
(Crash Carts, 2012).
Every unit has its own crash cart which is a portable trolley. Crash cart will be kept in a place where
it is easy to take and easy to use, and regularly watched and supervised by staff nurse to make sure
that all supplies are replaced and checked by registrar weekly and by hospital inspection team
monthly. All the equipment in the crash cart will be in working condition and emergency life saving
drugs up–to date (Clinical Practice, Policy Procedure, 2012).
Nurses and doctors are the first in line that provide life support and bringing back to normal life.
They should always be aware of the location and placement of the emergency cart and their contents
and their use properly. Staff must be familiar with all of life saving equipment within their working
area (Shannon,

Airway Management Plan
Patients presenting to the operating theatre for emergency surgery often require complex action
plans. Minimal screening or preparation time and the underlying illness pathology contribute to their
complexity. The combination of Mr Knight's underlying hypertension, diabetes and obesity with his
suspected bowel obstruction put him into the complex patient category. This anaesthetic plan will
discuss Mr Knight's comorbidities and a selection of anaesthetic techniques. Techniques discussed
will focus on a number of difficult airway techniques, both invasive and non–invasive monitoring
methods, the importance of fluid management, camponography, planning for discharge to the post
anaesthetic care unit (PACU) and documentation. When planning ... Show more content on
Helpwriting.net ...
Instability during this period can lead to hypoperfusion resulting in poor tissue perfusion and
oxygenation thus leading to infectious complications and organ dysfunction (Scheeren, Wiesenack,
Gerlach, Marx, 2013). The kidneys are particularly susceptible to hypoperfusion as a result of
cardiac dysfunction, hypovolemia and systemic hypotension. Preventing these injuries are achieved
by perioperative hemodynamic stabilisation (Brienza, Giglio, Marucci, Fiore,

Essay On Obstetrics And Gynecology Clerkship
I arrived at the decision to pursue a residency in anesthesiology over the course of personal and
clinical experience. A few months before medical school, my eldest child, Ben, had to undergo a
scheduled operation. Because of his autism, my son was afraid of visiting new places. I took him to
the hospital, concerned more about the adequacy of anesthesia than the surgery itself. As I
anticipated, the staff called me urgently into the operating room after Ben pulled his IV line and
refused to settle on the operating table or accept a new IV line. The anesthesiologist asked for
permission to administer inhalation induction to my child. The quick thinking and actions in a
critical setting by anesthesiologist that day won my trust and relieved my worries.
Most of my exposure to anesthesiology occurred in the course of various clinical clerkships.
Reservations over anesthesia were not uncommon for patients. During Obstetrics and Gynecology
clerkship, some of the women in labor were dubious about possible side effects of anesthesia. One
of them, patient SM, initially declined anesthesia. As her pain grew more agonizing, she asked how
anesthesia ... Show more content on Helpwriting.net ...
My profound interest in physiology and pharmacology aligns well with the goals of advancing
hands–on experience and performing quick actions in critical states.
I seek anesthesiology residency with opportunities to participate in and learn from an extensive
variety of anesthesiology procedures and operations under the direction of managing faculty. Upon
completion of anesthesiology residency, I will continue my training with a fellowship in critical care
medicine. I will then practice anesthesiology and pursue academic activities to continue knowledge

REM Behavior Disorder (RBD)
REM behavior disorder (RBD) is a neurodegenerative brain disorder that causes abnormal sleep
phenomenon in which individuals act out their dreams. Individuals RBD have been observed flailing
their arms and legs as if defending themselves against imaginary enemies. In some severe cases,
people with RBD have gotten out of bed, driven cars, harmed themselves, and assaulted family
members. In one of the more frightening cases of RBD discussed during the lecture, a police officer
awoke with his gun pointed at a door, as if defending himself against an intruder. This disorder has
even been used, both successfully and unsuccessfully, in court as a murder defense. There are five
phases of sleep which are, stages 1, 2, 3, 4, and REM sleep or, rapid ... Show more content on
Helpwriting.net ...
During the 1930s there was extensive use of this technology in caring for victims of the polio
epidemic. These iron lungs were cumbersome, and provided little access to provide patient care.
Recent advancements however, have made negative pressure ventilation a viable option in non–
invasive mechanical ventilation. The modern iron lung consists of a flexible cuirass, or shell,
which is designed to fit over the anterior of the chest. On inspiration, a negative pressure helps to
pull the rib cage up and forward, increasing the space in the thoracic cavity, facilitating better air
flow and ventilation. Expiration is achieved by passive recoil. These latest devices offer many of the
same ventilatory modes as positive pressure vents do, as well as, high frequency chest wall
oscillation and cough assistance. The HFCWO assists patient in mobilizing secretions much the
same way the vest works in chest physiotherapy. The cuirass can also provide peep by providing a
continuous negative distending pressure baseline. This negative extrathoracic pressure provides a
new functional reserve capacity (FRC) from which the patient can breathe from. Biphasic cuirass
ventilation can also provide a positive pressure to assist in assist in exhalation. This positive phase
decreases the potential for large end expiratory lung volumes which may facilitate gas trapping or
barotrauma to compromised lung

Raynaud Case Summary
Glossal pulse oximetry for anaesthetic management of patient with Raynaud's phenomenon.
Raynaud's phenomenon, is a disorder of the microvasculature due to vasoconstriction of the digital
arteries, arterioles, and cutaneous arteriovenous shunts, affecting the fingers and toes but can present
on nose, ears and nipples. Continuous pulse oximetry, a standard basic anaesthesia monitoring as per
the American Society of Anaesthesiology (ASA) recommendation, could be challenging for these
patients posted for surgery under anaesthesia. We discuss a case of Raynaud's phenomenon where
glossal pulse oximetry was used intraoperatively.
A 65–year–old female, case of adenocarcinoma of lung was posted for radiofrequency ablation
under general anaesthesia. ... Show more content on Helpwriting.net ...
High cost of the Nasal Alar SpO2 sensor, £20.62 per unit may deter its use in resource limited
settings. Alternatively, invasive arterial line could be inserted to measure arterial blood gases pre–
induction, post intubation and following extubation, which could give a better information in such
patients posted for major surgeries.
In this era of newer gadgets, we hope that reporting of this case will help in familiarizing the newer
generation of anaesthesiologists to this old lost technique. In conclusion, glossal oximetry is a
valuable method of intraoperative pulse oximetry in patient with Raynaud's phenomenon.
References:
1. Coté CJ, Daniels AL, Connolly M, Szyfelbein SK, Wickens CD Tongue oximetry in children with
extensive thermal injury: comparison with peripheral oximetry, Can J Anaesth, 1992; 39: 454–7.
2.Hickerson W, Morrell M, Cicala RS. Glossal pulse oximetry. Anesth Analg 1989;

Rotator Cuff Surgery: Case Study Questions
Rotator Cuff Surgery Case Study Questions
Q1. Identify the psychosocial impact of surgical intervention including the psychosocial impact of
elective and emergency admissions, separation, and loss of income and/or loss of control as related
to the case study The patient at the center of the present case study is an excellent demonstration of
the way that psychological and sociological needs impact the experience of receiving medical
treatment. In this case, the subject's emotional well–being is at stake due to the fear of lost income,
financial security and earning capacity related to surgery. In Adam's case, one of the biggest flaws in
his treatment plan appears to be the failure of attending care providers to match the subject with a
proper intervention. The result is a poor management of the psychosocial implications of his
otherwise simple procedure. According to the research by Ruiz–Suarez Barber (2008), one of the
best ways to positively impact the outcome of surgery, especially in terms of pain management,
involves this psychosocial strategy. According to the study, efforts at postoperative pain reduction
should begin preoperatively with the establishment of an excellent patient/physician relationship.
Adequate counseling as to the nature of the condition and what the procedure entails should be
provided. (Ruiz–Suarez Barber, p. 3) It could be argued that such preoperative relationship–
building did not occur for Adam. The subject entered surgery under a

The Field Of Critical Care
Introduction
The field of critical care is rapidly changing. It is important for anesthesiologists be knowledgeable
of these changes for providing care to critically ill patients in the perioperative period. The purpose
of this chapter is to provide update for clinicians on ICU issues relevant to clinical practice. Topics
which will be discussed include: modes of mechanical ventilation, renal replacement therapy,
antibiotic prophylaxis, nutritional support, sedation management, transport and transfer of care.
I. Modes of Mechanical Ventilation
Introduction
Most patients undergoing general anesthesia for surgical procedures require mechanical ventilation.
One of the biggest challenges facing clinicians providing mechanical ventilatory support today is
managing the balance between providing adequate gas exchange and avoiding lung injury associated
with positive pressure ventilation. Patients with respiratory failure need adequate tissue oxygenation
and acid–base balance; however, the lungs are fragile structures that can be injured by over–
distension, alveolar collapse and reopening, and high oxygen exposure. This challenge in providing
lung protective ventilation is made more difficult by the fact that lung injury is often
heterogeneous and thus what may benefit gas exchange in one region (e.g., higher pressure) may
worsen injury in another.
Modern anesthesia ventilators are becoming increasingly sophisticated provide high performances in
delivering accurately and

Literature Review Of Literature On Influenza
Review of literature: Acute respiratory infections are a major cause of human disease and are one of
the most important causes of child mortality throughout the globe. Though there are considerable
variations in infantile mortality, according to World Health Organization, the lower respiratory tract
infections are the second most important cause of death among children 5 years of age. (Carolina
et al., 2012)
Respiratory syncytial virus is most frequently detected in childhood illness. Factors predisposing to
severe ARI caused by RSV are well known in industrialized countries but little information exists
for developing countries. Infection with human metapneumovirus (HMPV) presents similar clinical
symptoms to that of RSV . Despite ... Show more content on Helpwriting.net ...
The multiplication of the virus occurs in the respiratory tract and the main site of infection occurs in
the ciliated columnar epithelial cell. Crowded areas and cold climate favours the spread of the virus.
Highest incidence of influenza infection is seen in young population which may be due to lack of
exposure to different strains. Children are mainly affected during epidemics (Rao, 2003). The
influenza virus triggers pulmonary inflammation resulting in infiltration of inflammatory cells and
an immune response. The primary target and the principal host for the virus are Bronchial epithelial
cells. Generally influenza viruses are recognized and destroyed by innate immune mechanisms
which includes macrophages, interferon (IFN) a, b and other cytokines, natural killer (NK) cells and
complement. If influenza viruses escape from these early defense mechanisms, they are captured
and destroyed by adaptive immune mechanisms, where T and B cells and their antigen–specific
effectors (cytotoxic T lymphocytes, cytokines such as IFNc and antibodies) target the virus.
subsequent viral infection is prevented by Antigen–specific memory cells (T and B cells) (Capelozzi
et al.,

Describe The Maximisation Of Anticoagulation Of...
(Karmiova, 2001) and is predictive of subsequent multiple organ failure, infection and than
eventually death in these patients. These conditions have many features common with sepsis. Blood
concentrations of various cytokines, soluble receptors and endotoxins increase within as early as 3
hours after cardiac arrest, the magnitude of these changes is associated with the outcome. Activation
of blood coagulation without adequate activation of endogenous fibrinolysis is an important
pathophysiological mechanism that may contribute to microcirculatory reperfusion disorders
(Böttiger, 1995). For patients that undergo CPR and achieve ROSC, their
coagulation/anticoagulation and fibrinolysis/antifibrinolsis systems are activated. Anticoagulant
factors such as antithrombin, protein S and protein C are decreased and this decrease is associated
with transient increases in endogenous activated protein C after resuscitation (Adrie,2005). The
stress of total–body oxygen debt also affects adrenal production and function. Although patients
have increased plasma cortisol levels they have a relative adrenal insufficiency defined as failure to
respond to corticotrophin. This failure to respond causes the adrenal cortex to not be stimulated to
secrete the hormones necessary to respond to stress.

Dr. James Hardy Performed The First Successful Long Term...
Dr. James Hardy performed the first human lung transplant in 1963, although the patient only lived
18 days.1 The first successful long–term lung transplant was performed in 1983 in Toronto.
Recipients of the first lung transplants were plagued by infection, rejection, and most significantly,
bronchial anastomotic dehiscence.2 However with advancements in bronchoscopy, ventilation
perfusion screening, echocardiography and radiological imaging, there are other post–surgical
complications which have been identified as important risks for lung transplant patients.
Lung transplantation can take two forms: 1) as a single–lung transplant (to either side via
thoracotomy) or 2) as a bilateral–lung transplant (via bilateral thoracotomies or via a ... Show more
content on Helpwriting.net ...
While the donor lung is being prepared and removed from its cold ice gauze (a technique to extend
the cold preservation time), the pulmonary vessels within the thorax are clamped off. When
considering order of re–anastomosis and insertion of the donor lung, bronchial arteries are
reattached first, followed by the pulmonary artery, then the pulmonary veins.2 Before the final
sutures are tightened, the donor lungs are inflated and aerated. The final steps of the procedure
include a bronchoscopy, which examines the airways and detects any unwanted blood or secretions.
However, bronchoscopies should be done sparingly as their uses may cause a delayed pneumothorax
in a lung transplant patient.3
Post–transplant, patients are monitored very closely in the intensive care unit (ICU) and
pharmacological and mechanical management is implemented when necessary. Within the first 24–
48 hours after surgery, a patient is ventilated and their Po2 and Pco2 levels are scrutinized. Diuretics
may be used in order to avoid any complications from fluid buildup or imbalances that may occur
and help with pulmonary recovery.2 Other complications that may occur within the first two days of
surgery include: technical complications, graft dysfunction, infections, and rejection. Stenosis of one
or more of the anastomoses accounts for 15% the technical complications, which may lead to graft
dysfunction.4 Other components of graft dysfunction incorporate pathology from

Anesthesiology Case Studies
My decision to pursue a residency in anesthesiology deliberately developed over the course of
personal and clinical experience. A few months before medical school, my eldest child, Ben, had to
undergo a scheduled operation. Because of his autism, my son becomes quickly agitated in an
unfamiliar environment. Therefore, while waiting in the surgical family area, I worried more about
the adequacy of his pre–operative anesthesia and less about the operation itself. The fears came true
when the staff called me urgently into the operating room. Ben had pulled his IV line and refused to
settle on the operating table or accept a new IV line. The anesthesiologist asked for permission to
proceed with a mask inhalation induction to my child. The quick ... Show more content on
Helpwriting.net ...
The procedures manifested the diligence and swiftness required in performing anesthesia–related
management. Moreover, the techniques were essential in revising physiological disturbances and
maintaining pharmaceutical intervention throughout operations. Additionally, communication with
pre–operative patients and opportunities to alleviate their concerns provided confidence in the power
of anesthesia. As for anesthesiologists, their skills to quickly gain confidence of patients during brief
pre–operative checkups, relieve patients' anxiety, and promptly respond to hemodynamic variations
in anesthetized patients were nothing short of inspiring. Working in the Surgical and Medical ICUs,
PACU, Emergency Department, and on the Psychiatric Consultation–Liaison Service exposed me to
a variety of patients in grave conditions and the need to closely monitor patients in a high state of
readiness to address their fluctuating

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