The Louisiana Floods

 

over the course of 5 days 6,900,000,000 gallons of rain fell and lead to one of the biggest disasters in the U.S. since hurricane Sandy. 11% of the states population was affected by this flood and 13 people lost their lives as a consequence. In looking at the healthcare perspective the demand for medical care, resources, food, shelter and clean up help were great but the amount of resources available were insufficient. Because of a delay declaring a state of emergency it took several days for the people in Louisiana to get the help and resources they so desperately needed. In addition, due to the massive power outages it was difficult to communicate with the people in the flooded areas and assessing the damage was further complicated by the massive amounts of water that prevented any personal from reaching the area other than via boat. The main health care needs included small injury treatment, sanitation resources, and preventing infection from stagnant water and mold which quickly became the biggest threat to the health and well-being of the population. Moreover, mental health needs were also found to be in great need as many individuals suffered PTSD as a result of the floods and having lost everything many people in the area became depressed. In the months following the suicide rate increased significantly as a result of this disaster. The Red Cross and FEMA were first on scene after which the US department of Health and Human services deployed two national disaster medical assistance teams to aid in the management and clean up efforts required to help the numerous communities of people who lost everything. Socioeconomics played a role in this disaster in several ways, however, the most notable being that because of the low income in the hardest hit areas very few had home insurance. The trauma care that was required for this disaster included basic first aid and infection prevention. Given the slow response time and public scrutiny at how this situation was handled, it seems that the next disaster would be handled differently specifically in response to response time by governmental agencies.

 

Advanced Neurological Monitoring

An article¬†titled “Advanced Neurological Monitoring” was published in 2016 in the Oxford Journal discusses the advantages of using intensive neurological monitoring in conjunction with conventional monitoring to promote better outcomes in patients who have suffered traumatic brain injuries (TBI) and/or subarachnoid hemorrhage (SAH). The monitoring modalities included in the discussion involve the following: pressure monitoring, cerebral perfusion pressure monitoring, jugular bulb oximetry, transcranial doppler ultrasongraphy, brain tissue oximetry, near infrared cerebral spectroscopy, cerebral microdialysis, cerebral imaging, and continous EGG. This article suggests that using a combination of the above listed monitoring strategies will improve outcomes through early detection and intervention secondary to advanced monitoring. Furthermore, it is suggested that “An integrated approach to measuring intracranial pressure alongside cerebral oxygenation and metabolites may therefore be useful in predicting patients at risk of deterioration.” Through use of a variety of measurements nurses and physicians are able to gain a more clear understanding of the cellular and pressure changes occurring in the brain of a patient who has sustained a TBI or SAH. Below is a summary of the purpose of the above mentioned monitoring strategies:

Pressure Monitoring: the intraventricular catheter is considered the most accurate way of monitoring and draining CSF

Cerebral Perfusion Pressure: is equal to the MAP- ICP. CPP below 50mmHg is directly related to blood flow and means ischemia may occur in the brain injured patient and leads to poorer outcomes. Target CPP should be between 50-70 mmHg

Jugular Bulb Oximetry: catheter that is inserted into internal jugular vein. normal oximetry for such a catheter is between 55%-85%, if less than 55% the patient has a deficit of cerebral oxygen delivery. The most common reason for jugular bulb desaturation is reduced CPP secondary to increased ICP. “Acute hyperventilation is a life saving ICP-reducing maneuver that can be titrated to SjO2 lmiting hypocapnia-induced vasoconstriction and ischemia”. ( Ralph & Singh, 2016, p. 95)

Transcranial Doppler Ultrasonography: non-invasive tool used to help approximate cerebral blood flow. This monitoring tool is most commonly used to assess for vasospasm, cerebrovascular autoregulation, emboli detection and, cerebral perfusion (Ralph & Singh, 2016).

Brain Tissue Oximetry: this is used to assess oxygen tension within brain tissues extracellular fluids. It is thought that balancing oxygen delivery through this type of monitoring improves patient outcomes.

Near Infrared Cerebral Spectroscopy: non-invasive method to assess cerebral oxygen concentrations. Mostly used in pediatrics but has proven helpful in TBI and SAH patients as well

Cerebral Microdialysis: used to assess and quantify the extracellular fluid makeup inside the brain itself. It filters small molecules through diffusion and allows for sample testing of the fluid drained to assess for chemicals, drugs and byproducts of metabolism

Cerebral Imaging: produces very detailed photographs of the metabolic and hemodynamic status of the brain (Ralph & Singh, 2016)

Continuous EEG: allows for the early recognition and rapid intervention of a patient experiencing seizure activity which often occurs after TBI and SAH.

 

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