Category Archives: Uncategorized

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.

 

Who knows about drugs??

In talking with my roommates and co-workers I was pleasantly surprised that no one is currently taking any medications other than birth control for the most part. Because many of my peers are not taking anything currently it was hard to assess if they knew about medications. I asked them about some common medications such as aspirin and acetaminophen to get a gauge for how much knowledge they had about OTC medications. As I suspected many of the people I talked to knew when you should take the medications i.e for a headache or fever, but did not know anything else about the medication. They were surprised to hear that both the medications can be overdosed on and can cause problems long term if not taken responsibly. The general consensus I got from those I interviewed is that if the medications are sold OTC they must be safe. It was interesting because being in the medical field we know the far reaching implications and uses of medications like aspirin and I think we often forget that the information we know is not necessarily common knowledge. In my interviews and the follow up discussion I was able to tell my friends and peers about the common uses of several OTC medications and what were possible side effects. My general opinion in reflecting on these discussions is how often people take pills without knowing what they are for, what the safe dose is, what the expected side effects vs adverse reactions could occur etc.

Hemolung Respiratory Assist System

The Hemolung Respiratory Assist System is a new technology in the respiratory field, and is solving some of the long standing issues associated with mechanical ventilation and ECMO in critically ill patients. The technology behind this device is similar to how a dialysis machine functions, and it is used to provide extracorporeal CO2 removal in a minimally invasive way. The way this machine works is similar to ECMO, however, the rate of blood flow and the catheter used in this device are both smaller and it runs on a single circuit. Unlike traditional ECMO this device produces effective CO2 removal through active mixing of gases, meaning that a smaller surface area of membrane and blood flow are required to remove the CO2 from the body. Furthermore, fibers in the machine allow oxygen gas to be drawn through the machine via a pump that facilitates CO2 exchange and oxygen diffusion into the blood. Also unlike the traditional ECMO the Hemolung is the first device to be created specifically for CO2 removal, and it allows for patient ambulation!

Great Respiratory Website!

Below I have posted an awesome website for care providers and patients about respiratory management! This website is  the American Association of Respiratory Care. This website has a wide variety of resources about all different types of respiratory issues. Many of the resources are patient friendly, which might be a good resource for patient education!  https://www.aarc.org/education/

Talking to the public: What does cardiopulmonary arrest, MI and CPR mean to you?

In reflecting on my conversation with one of my best friends I was surprised to find that she knew about the questions I posed concerning heart attacks. In response to cardiopulmonary arrest she quickly explained to me what the cardio and arrest part meant, however, she was not able to link to back to the pulmonary component of the question. It was interesting to me how someone who I consider to be very well read and intelligent could not know something that we as health care professionals think of as second nature. Moreover, she was able to explain CPR and what an MI was to me with relative ease. When I asked her where she learned that information she laughed and said I explained it to her back when I stared nursing school. We discussed how she felt her knowledge stacked up to the knowledge other people in the general public had concerning CPR and cardiac arrests and she made the good point that unless you seek out the information, these topics are not generally talked about in school, jobs etc. Overall, I think this conversation was enriching for both of us and we came to the conclusion that people should be required to take an CPR/AED class when they get their drivers licences to improve common knowledge and MI survival rates. 

 

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