Elevated intra-abdominal pressure (IAP) is associated with several conditions including sepsis, severe acute pancreatitis, acute decompensated heart failure, hepatorenal syndrome, hypervolemia secondary to intravenous fluid resuscitation, raised intrathoracic pressure due to mechanical ventilation, extensive burns, and acidosis. Laparoscopic surgery has emerged to be an additional prominent cause of elevated IAP due to abdominal insufflation with carbonic dioxide (pneumperitoneum). In the past two decades, it has rapidly replaced the open approach in many surgical specialties as it has been reported to produce superior results in several aspects but the propensity of laparoscopic surgeries to cause elevated IAP is concerning. Although the
How does this history of high blood pressure demonstrate the problem description and etiology components of the P.E.R.I.E. process? What different types of studies were used to establish etiology or contributory cause?
Risk assessment scales have been in situ for over 50 years within the adult sector. These scales consist of several categories, which are thought to be associated with the potential occurrence of a pressure ulcer. Factors such as mobility and incontinence etc. are considered. Each category of the assessment is added up to give a total. The score then suggests whether a patient is at low, medium or high risk of developing a pressure ulcer. Higher-risk patients are therefore more susceptible to develop pressure ulcers and interventions are implemented such as, Air mattresses or nutritional support which is hoped to reduce the occurrence of pressure
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room and after induction a general endotracheal anesthetic, the abdomen was prepped and draped in a sterile manner. Then, 0.5% Marcaine was injected superior to the umbilicus and a longitudinal skin incision was made and carried down to the anterior abdominal wall fascia which was incised in the midline. Two stay sutures of 0 Vicryl placed on either side of the fascial incision. The peritoneum was entered under direct vision with Mayo scissors. A Hassan trocar is inserted into the peritoneal cavity and secured to the
Walker, H. (1990). Chapter 93Inspection, Auscultation, Palpation, and Percussion of the Abdomen. In Clinical methods: The history, physical, and laboratory examinations (3rd ed.). Boston:
I will review RNAO’s Best Practice Guideline: “Risk Assessment and Prevention of Pressure Ulcers” – by September 26 (RNAO,
Wildgruber and Rummeny (2012) define tension pneumothorax is a life-threatening condition where air enters the pleural cavity during inspiration but cannot escape during expiration. It is more common in patients with chest traumas and those with mechanical ventilations (Briggs, 2010). Increased the thoracic pressure will compress against the heart and the unaffected lung impairing cardiac functions and ventilation (Pons, & National Association of Emergency Medical Technicians, 2011). Rapid intervention is required to prevent fatal conditions include hypoxia, shock, cardiorespiratory arrest and death (Wildgruber & Rummeny, 2012; Day, 2011; Bethel, 2008).
Shouldice Hospital has developed a highly specialized technique for hernia operations. This hospital has a competitive advantage to other organizations providing hernia operations because they us a superior method to repair the hernia, are able to maintain relatively low costs, and have high patient satisfaction. Their strategy is if focused mainly on the psychological affect operations can have on a patient. If a patient is fully sedated during the operation, and afterwards told to stay in bed their healing progresses much slower. The goal of Shouldice hospital is to have patients immediately active post operation. They tell the patient that they are able to get up and walk around, therefore the patient doesn’t feel “put
Abdominal Compartment Syndrome (ACS) is a sustained intra-abdominal pressure greater than 20 mm Hg. This syndrome is associated with organ failure or dysfunction. If ACS is not recognized and treated promptly it can result in mortality. Cases that are not recognized and treated promptly have a 90% to 100% mortality rate. 46.8% pediatric doctors can recognized ACS, this is not near the percentage that it needs to be. Only 51% of pediatric doctors have had to treat a child with ACS so it is not an extremely common disease. ACS can be diagnosed bedside by measuring the IAP of the patient. In a case study concerning a 13 year old boy, he was brought to the emergency room after being kicked by a horse. The patient was taken into surgery for an exploratory
A patient undergoing surgery has only a few concerns regarding a successful operation. The main priority is the efficacy of the operation itself. Equally critical to a patient, however, is the assurance of anesthesia. Precise methods of anesthesia application vary according to each patient’s physiological conditions. Clinical anesthesia use on the obese is particularly complex, posing dangers to the patients. As complications continue to arise from the use of anesthesia on the obese, mandatory measures such as additional anesthetist training should be implemented on all perioperative stages to reduce risks to this growing patient population.
Long et al., states that numerous studies indicate that a combination therapy with drugs of different classes is more effective than a single dose treatment (2009). Also, Apfel et al., suggest in their study that increasing the number of antiemetics reduces the incidence of PONV from 52% when no medication is given to 37%, 28%, and 22% when one, two, or three anti-nausea drugs are administered (2004). Use of multiple medications to decrease the incidence of PONV will improve patient outcomes thereby reducing anxiety about surgery and increasing all around patient satisfaction. Failing to utilize such evidence could result in increased incidence of PONV; which leads to other postoperative complications. Pulmonary complications due to aspiration, wound dehiscence, hematoma development, will hurt the patient quality of life, and delay discharge from the post-anesthesia care unit (PACU); ultimately delaying discharge home (Tinsley, M. H., & Barone,
Sayar S.,Turgut, S., Dogan, H., Ekici, A., Yurtsever, S., Dermirkan, F., Doruk, N., Tsdelen, B. (2009) Incidence of pressure ulcers in intensive care unit patients at risk according to the Waterlow scale and factors influencing the development of pressure ulcers. Journal of Clinical Nursing 18, 765-774.
A do not resuscitate order for patients who have emergency surgery is an “independent risk factor for poor surgical outcome and postoperative mortality” (Kelley , 2014 pg 1 para 3) and the probability of returning patients to their previous level of functioning is higher for CPR performed during the peri-operative period (Kelley , 2014).
Alveolar hyperventilation causes a decreased partial pressure of arterial carbon dioxide (PaCO2). The decrease in PaCO2 increases the ratio of bicarbonate concentration to PaCO2 which increases the pH level. The decrease in PaCO2 develops when a strong respiratory stimulus causes the respiratory system to remove more carbon dioxide than is produced. Respiratory alkalosis can be acute or chronic. Acute respiratory alkalosis is when the PaCO2 level is below the lower limit of normal and the serum pH is alkalemic. Chronic respiratory alkalosis is when the PaCO2 level is below the lower limit of normal, but the pH level is relatively normal or near normal. Respiratory alkalosis is the most common acid-base abnormality observed in patients who are critically ill. It is associated with numerous illnesses and is a common finding in patients on mechanical ventilation. Many cardiac and pulmonary disorders can occur with respiratory alkalosis. When respiratory alkalosis is present, the cause may be a minor or non–life-threatening disorder. However, more serious disease processes should also be considered in the differential diagnosis (Byrd, 2017). Hyperventilation is most likely the underlying cause of respiratory alkalosis. Hyperventilation is also known as over breathing (O’Connell, 2017).
“Whoa-oa-oa! I feel good, I knew that I would now. I feel good….”. My “I feel good” ringtone woke me up from the depths of slumber during my first night call in internal medicine rotation. My supervising intern instructed me to come to the 4th floor for a patient in distress. Within moments, I scuttled through the hospital hallways and on to the stairs finally arriving short of breath at the nurses’ station. Mr. “Smith”, a 60 year old male with a past medical history of COPD was in respiratory distress. He had been bed bound for the past week due to his severe arthritis and had undergone a right knee replacement surgery the day before. During evening rounds earlier, he had no signs of distress. However, now at 2 AM in the morning, only hours later since rounds, he was minimally responsive. My intern and I quickly obtained the patient’s ABG measurements and subsequently initiated a trial of BIPAP. This resolved Mr. Smith’s respiratory distress and abnormal ABG values. To rule out serious causes of dyspnea, a stat chest x-ray and CT were obtained. Thankfully, both studies came back normal.
The current patient may be experiencing a range of traumatic injuries after his accident, the injuries that the paramedic will focus on are those that are most life threatening. These injuries include: a possible tension pneumothroax or a haemothorax, hypovolemic shock, a mild or stable pelvic fracture and tibia fibula fracture.