After review of the clinical information provided by North Central Bronx Hospital, the Medical Director has denied your admission to North Central Bronx Hospital. It was determined that the clinical information did not justify an inpatient stay. Acute inpatient hospitalization was not medically necessary. You are a 56 year old female with complaints of worsening pressure-like chest pain on the left sided that radiated to your left arm and neck. The symptoms began when you were at rest and woke you from your sleep. Based on the Interqual guideline (a decision based program to determine medical need) criteria to for acute coronary syndrome the clinical guidelines were not met because troponins were negative, there was no diagnostic testing such as a stress test, or documentation of ischemia in the clinical information that was submitted. …show more content…
You could have been treated symptomatically while awaiting test results. Consultation with other healthcare professionals could also have been done in observation. There was no hemodynamic (blood), pulmonary (lung) or metabolic (chemical process) measurement or physical exam result that justified the need for acute inpatient level of care. You could have been kept in observation according to guidelines as there was no electrocardiogram (recording of your heart activity) change and there were no positive biomarker tests (blood tests for the heart) or other finding that would require admission to acute care. Also there was no planned intervention that would have required an acute inpatient level of care. With negative test results for an acute cardiac or other event the member could have been discharged from observation with ambulatory plan of
In the case of Riser v. American Medical Int’l, Inc., Riser, a 69-year-old mother of four children, was suffering from circulation complications in her lower arms and hands. She had a history of several conditions such as diabetes mellitus, end-stage renal failure, and arteriosclerosis. The physician at Hospital A, Dr. Sottiurai, requested bilateral arteriograms to find the etiology of Riser’s circulation problems. However, Hospital A could not fulfill Dr. Sottiurai’s request, so Riser was transferred to Hospital B under the care of Dr. Lang, who was a radiologist. At this instance, Dr. Lang mistakenly performed a femoral arteriogram instead of the bilateral arteriogram that Dr. Sottiurai had originally ordered, and after the procedure when Riser was on her way to be
The purpose for the stent was to hold the coronary artery open to allow the blood to flow more freely.
The staff believed the patient’s altered behavior was due to the possible drug withdrawals. While the symptoms are similar, there are distinct differences between hypovolemic shock- secondary to blood loss, and acute opiate withdrawals. With a thorough exam, the staff should have been able to recognize this difference. The Clinical Opiate Withdrawal Scale, (Wesson, D. R., & Ling, W., 2003) would have been the proper objective measurement tool to be able accurately, assess the patient. Another breach of duty was not getting the CT scan down in an appropriate amount of time. The physician had a high index of suspicion that the patient was bleeding internally, yet the CT was not completed until the following morning. Lastly, the patient admitted to a substance abuse problem, yet a drug screen was not ordered. If it had been, they would have seen there were no opiates in his system and he was positive for alcohol and benzodiazepines.
There are various treatments for acute coronary syndrome to prevent the occurrence of an acute myocardial infarction. The purpose of this essay is to discuss the current research of the pharmacological treatments of this condition and to evaluate the relevance of this research in relation to the practise of paramedics.
The human body is an amazing machine, we have cells, tissues, organs and organ system that come together to create the human race. Each system plays a key role in our bodies mechanism. Without each systems our bodies would not function properly, but what happens when one of these system fails? The Cardiovascular system components are blood, blood vessels and the heart. The hearts function is to pump blood to all the major organs and tissues (Circulatory). It’s also important to be aware of the derivation that our bodies may encounter, for example a stroke. In this passage I discuss different types of strokes, what are the signs and symptoms and after care for this disorder of the cardiovascular system.
A.B. presented to the emergency department (ED) complaining of severe substernal chest pain that lasted for four hours and that he described as “crushing”. He reported that the pain radiated to his neck and jaw. Additionally, the patient was experiencing shortness of breath (SOB).
In order to know what myocardial infarction is, it is important to know when to diagnose the condition and to do it as soon as possible. It is vital to be able to know the sign and symptoms for a myocardial infarction and how to treat them to prevent any further damage to the myocardium. Since damage can occur to the myocardium, heart muscle, one of the goals is to save as much of the heart muscle as possible through procedures to be able to open up the blood vessels to make sure blood is traveling to the heart and heart muscles like a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery.
There was inappropriate staffing in the Emergency Room which was a factor in the event. There was one registered nurse (RN) and one licensed practical nurse (LPN) on duty at the time of the incident. Additional staff was available and not called in. The Emergency Nurses Association holds the position there should be two registered nurses whose responsibility is to prov...
This paper will critique a quantitative research study (Lesnecki, 2010) that examined influences of individuals that delayed seeking treatment during an acute myocardial infarction (AMI). The article examined psychosocial and environmental influences that may have played a role for the period of AMI symptom onset to actually obtaining medical treatment. The research study will be reviewed looking at background, study purpose, design and methodology, data analysis, results, discussion, limitations, and applications for nursing practice.
An acute myocardial infraction is commonly known as a heart attack. A heart attack is a serious medical emergency that can cause death if not taken serious! “Every year, there are more than 3 million cases in America.” Says Mayo Clinic. Although, a heart attack can happen at any age the majority of the victims are 40 and up. An attack occurs when the blood supply to a part of the heart is damaged or interrupted. Heart attacks are usually caused by obesity, stress, high blood pressure, smoking and many other diseases or poor decision.
The primary concern for Mr. Miller would be preventing further ischemia and necrosis of the myocardial tissues, preventing serious complications such as cardiac dysrhythmias and heart failure, as well as relieving his chest pain that radiates to his left arm. Preventing further ischemia and necrosis of the myocardial tissue will help prevent the development of heart failure due to myocardial infarction, whereas relieving his pain will help reduce his episodes of shortness of breath, and will also help to reduce any anxiety and restlessness he may be having from being in pain and short of breath.
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
Coronary artery disease (CAD) is one of the most common types of heart diseases. In the United States, CAD is the leading cause of death in both men and women. The disease occurs when a waxy substance called plaque builds up inside the coronary artery. The coronary arteries supply oxygen-rich blood to your heart muscles. Both of my grandfathers suffer from coronary artery disease and I want to learn more about the disease to better understand how it affects them both mentally and physically.
Roger, Go, Lloyd-Jones, et al. states “Cardiovascular disease is the leading cause of death in the United States for men and women of all racial and ethnic groups.” (As cited in Hinkle & Cheever 2014, p. 729). There are different types cardiovascular diseases and they have a lot in common in terms of characteristics. This paper will focus on discussing acute coronary syndrome and myocardial infarction. To distinguish the two from each other, it is important to know the similarities and differences in etiology, clinical manifestations, medical management, collaborative care and nursing management for these two diseases.
I’m going to review the case of a 73 year old female who was transferred to the Emergency room after collapsing in back yard. Prior to her collapse she was talking on the phone with a friend who reported “patient seemed confused”. Upon arrival to the hospital patient complains of difficulty with breathing. Her respirations and heart rate are elevated and her previous history includes diabetes and hypertension. Patient states she “just started a new blood pressure medication, Lisinopril”. Her other medications include metformin for diabetes and hydrochlorothiazide for fluid retention. Patient becomes unresponsive and is having more difficult time breathing.