A pilot randomized controlled trial is the second study that will be looked at and was published in 2012. It was entitled High-Concentration Versus Titrated Oxygen Therapy in ST-Elevation Myocardial Infarction. This study was also commonly referred to as Oxygen Protocols for the Treatment of Myocardial Infarction: Mortality, Infarct Size and Efficacy (OPTIMISE) (Ranchord, 2012). The purpose of the study was to find the optimal approach to oxygen therapy in ST-elevation myocardial infarction (Ranchord, 2012). This study was a prospective, randomized, unblinded, controlled trial undertaken at Wellington Hospital in New Zealand and South Manchester University Hospital NHS Trust, Manchester, United Kingdom (Ranchord, 2012). Subjects fell into …show more content…
The purpose of the study is to determine whether withholding routine supplemental oxygen therapy in patients with acute ST-elevation myocardial infarction but without hypoxia prior to reperfusion decreases myocardial infarct size (Stub D. S., 2012). The study was completed by the Ambulance Victoria, the main ambulance service in Melbourne, Australia, and twelve of the primary percutaneous coronary intervention hospitals in metropolitan Melbourne. Inclusion criteria was as follows: to enroll 490 patients, 18 years of age or older, who describe chest pain commencing less than 12 hours prior to assessment, ST-elevation Myocardial Infarction on pre-hospital 12-lead ECG following current ACLS guidelines (Stub D. S., 2012). ACLS guidelines state ST-segment elevation of greater than 1 mm in two contiguous limb leads or ST-segment elevation of greater than 2 mm in two contiguous chest leads or new left bundle branch block constitutes infarct or bundle branch blocks. Patients were excluded if they were hypoxic with oxygen saturation measuring less than 94% on pulse oximeter with the patient breathing air, having bronchospasm on examination that required nebulized salbutamol therapy using oxygen, received oxygen prior to randomization, or have any condition associated with altered conscious state (Stub D. S., 2012). The study …show more content…
The databases searched included the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library), MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO) and Web of Science (ISI). LILACS (Latin American and Caribbean Health Sciences Literature) and PASCAL (Cabello JB, 2013). Inclusion criteria was that the studies looked at had to be randomized control trial of individuals having myocardial infarction symptoms less than 24 hours where the intervention of oxygen vs air was studied. The search resulted in 4 trials involving a total of 430 patients of which 17 deaths occurred. Of the 17, more than twice as many people known to have been given oxygen died compared to those known to have been given air (Cabello JB, 2013). The researchers state that this number is too small to draw a truthful conclusion if oxygen is really harmful or if it was a matter of chance that those individuals died during the study. The overall researcher’s conclusion is that a definitive randomized controlled trial is urgently required. However, at this point there is no conclusive evidence to support the over use of oxygen in people with
Epinephrine can be added to NE if needed to maintain acceptable BP, or substituted if necessary. Vasopressin (0.03 units/min) can be used as an adjunct to increase MAP,or to lower NE dose; it should not be used as a single agent. Dopamine can be used as an alternative to NE, but only in patients meeting criteria due to risk of arrhythmias; low dose dopamine not to be used for renal protection. Phenylephrine not recommended in most cases; can be utilized if NE leads to serious arrhythmias, CO is known to be high yet BP continues to be low, or as salvage therapy when MAP target is not achieved by other means. An arterial cath should be placed ASAP in patients who require vasopressors. Inotropes can be added to vasopressors or used alone, with a doubatmine trial of up to 20 mcg/kg/min as an option if myocardial dysfunction is suspected by elevated cardiac filling pressures and low CO, or if hypoperfusion is still evident although intravascular volume and MAP are at goal. Bicarbonate should not be used in patients with pH greater than or equal to
The answers are A&D. Decreasing myocardial oxygen demand (heart rate control, preload/after load reduction) and Increasing myocardial oxygen supply (perfusion) are essential in the treatment of MI.
Myocardial infarction and acute coronary syndrome require the same medications such as: “aspirin, nitroglycerin, morphine, beta blockers, and thrombolytics” (Smeltzer, pp. 744, 2010) Oxygen administration and a 12-lead electrocardiogram is also required upon arrival to the hospital. A PCIS is a procedure for “opening the occluded artery and providing perfusion to the area of the heart that has been deprived of oxygen” and should be done in less than one hour of patient arrival (Smeltzer, pp. 745, 2010). When a PCI is contraindicated or unavailable at a certain facility, thrombolytics are admistered to “dissolve the thrombus in a coronary artery” in order for reperfusion to the deoxygenated area of the heart to occur (Smeltzer, pp. 745, 2010). After the initial medical treatment for acute coronary syndrome and a myocardial infarction, “continuous cardiac monitoring” is required to ensure that another episode is not going to occur (Smeltzer, 745, 2010). Monitoring is preferably done on an intensive care unit because of the severity of the complications that could occur. Medications such as “aspirin, beta-blockers, and an ACE inhibitor” is included in the ongoing treatment (Smeltzer, pp. 745, 2010). Cardiac rehabilitation is initiated after the patient with acute coronary
Patients with atelectasis will vary in their manifestations, depending on the degree of area affected. Typically, breath sounds will be reduced or diminished on the side of the alveolar collapse and oxygen saturation will be decreased because air is unable to fill the alveolar sacs where the process of ventilation-perfusion is supposed to take place (Lewis et al., 2014). According to Porth (2015), the patient may also exhibit tachypnea, diminished chest expansion, intercostal retractions, dyspnea, and tachycardia. These symptoms demonstrate how the body reacts and its attempt to compensate for the lack of oxygen. This lack of oxygenation to tissues results in cyanosis (Porth, 2015). An individual undergoing such difficulty to breath will present distressed and anxious. A thorough assessment of the patient and presence of some of these manifestations contribute to the diagnosis of atelectasis, which would be supplemented by a chest radiograph for confirmation (Porth, 2015). Most post-operative patients who fall victim to atelectasis and present with the signs and symptoms described, usually have risk factors that increase their probability of acquiring the
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
An electrocardiogram (ECG) is one of the primary assessments concluded on patients who are believed to be suffering from cardiac complications. It involves a series of leads attached to the patient which measure the electrical activity of the heart and can be used to detect abnormalities in the heart function. The ECG is virtually always permanently abnormal after an acute myocardial infarction (Julian, Cowan & Mclenachan, 2005). Julies ECG showed an ST segment elevation which is the earliest indication that a myocardial infarction had in fact taken place. The Resuscitation Council (2006) recommends that clinical staff use a systematic approach when assessing and treating an acutely ill patient. Therefore the ABCDE framework would be used to assess Julie. This stands for airways, breathing, circulation, disability and elimination. On admission to A&E staff introduced themselves to Julie and asked her a series of questions about what had happened to which she responded. As she was able to communicate effectively this indicates that her airways are patent. Julie looked extremely pale and short of breath and frequently complained about a feeling of heaviness which radiated from her chest to her left arm. The nurses sat Julie in an upright in order to assess her breathing. The rate of respiration will vary with age and gender. For a healthy adult, respiratory rate of 12-18 breaths per minute is considered to be normal (Blows, 2001). High rates, and especially increasing rates, are markers of illness and a warning that the patient may suddenly deteriorate. Julie’s respiratory rates were recorded to be 21 breaths per minute and regular which can be described as tachypnoea. Julies chest wall appeared to expand equally and symmetrical on each side with each breath taken. Julies SP02 levels which are an estimation of oxygen
My clinical rotation for NURN 236 is unique in that all patients I care for at Union Memorial Hospital in Baltimore, Maryland have a diagnosis of heart failure (HF). HF occurs when the heart is unable to pump adequate blood supply, resulting in insufficient oxygen and nutrients to the tissues of the body (Smeltzer, Bare, Hinkle, and Cheever, 2012). Approximately 670,000 Americans are diagnosed with HF each year and is the most common hospital discharge diagnosis among the elderly (Simpson, 2014). Moreover, according to the Centers for Medicare and Medicaid Services (CMS), HF is the leading cause of 30-day hospital readmission followed by acute myocardial infarction (AMI) and pneumonia (medicare.gov|Hospital Compare, 2013). This information along with my weekly HF patient cohort prompted my curiosity regarding impacts of HF readmissions, factors of HF readmission, and to compare suggested evidence based practice with policies utilized at Union Memorial for reducing the 30-day readmission rate for HF.
Liem E, Lin C, Suleman M et al. Anesthetic requirement is increased in redheads. Anesthesiology. 2004;101(2):279-283.
End tidal carbon dioxide (ETCO2) monitoring is the non‐invasive measurement of exhaled CO2. ETCO2 monitoring is one of the objective standards set in the Intensive Care Society guidelines 2002 for the transport of the critically ill adult, and is mandated by the American Heart Association in the new pediatric advanced life support guidelines, which state that all intubations must be confirmed by some form of ETCO2 measurement. It can be concluded that the use of capnography monitoring on ALL patients who receive PCA can reduce the incidence of adverse events from IV opioids in the postoperative setting.
In recent years, nursing scholars have developed many Evidence Based Practice (EBP) models to improve the implementation of research findings into nursing practice. Application of evidence based models can reduce the complexity of the challenge of transforming evidence into clinical practice. Effective EBP models to guide translation of research into practice are vital to avoid failure accompanied by a costly investment of time and resources. There are many EBP models, at times it can be confusing for clinicians to select an appropriate EBP model due to excess availability of models and various approaches in implementing EBP. Therefore, it is important for clinicians to aware about these models and select an EBP model that best-fit for their
Mrs. Green was admitted to hospital as she was experiencing chest pain that was continuous for around 10 minutes. During her admission in the emergency department she had a 12 lead Electro-cardiogram (ECG) which indicated that she was having a ST Elevation myocardial infarction (STEMI) (School of Nursing & Midwifery 2014). Mrs. Green was then taken to have a percutaneous transluminal angioplasty which stents were placed, that was completed using a femoral approach and then was transferred to the cardiac care ward and is planned to be discharged the next day (School of Nursing & Midwifery
There are some key distinctions between Randomized Controlled Trials (RCT) in a psychotherapeutic context and a medical context. There are key differences between the design of an RCT to evaluate a new drug and an RCT to evaluate a new form of couples’ therapy. However, it is important to begin by defining and understanding the importance of RCT in research (O'Brien, 2013).
Oxygen was first admitted to the client with chest pain over 100 years ago (Metcalfe, 2011). Chest pain is a large bracket that can contain many different conditions, but for the purpose of this analysis it is focused manly upon a myocardial infarction. A myocardial infarction is mainly referred to as a heart attack, and occurs when one or more coronary arteries leading to the heart reduce or completely stop blood flow (Tuipulotu, 2013 ). Administering high concentrations of oxygen to patients with chest pain is now embedded in guidelines, protocols and care pathways, even with a lack of clear supporting evidence (Nicholson, 2004 ). High concentration of oxygen means that up to 60% is administered (Knott, 2012). More recent research has suggested that the use of oxygen in this scenario is unnecessary and can lead to unwanted side effects, especially in normoxic cardiac patients (Moradkham & Sinoway, 2010 ). The aim of this comparative analysis is to dismantle and understand both the benefits and risks of the commonly known practice of administration of oxygen to the client with chest pain. Through completing this analysis using recent and appropriate evidence a more improved practice can be given and understood.
If early interventions are conducted, the mortality rate and ICU duration are highly decreased. In Hui el (2016) reviewed a journal regarding the application of protocols and procedures to reduce VAP, with his major goal being to evaluate the importance of early intervention of VAP in the ER. He found out that there is a need of initiating early intervention in the ER, including oral care with about 0.13% chlorhexidine, 30 to 40 degrees of elevation of the head in bed, administration blockers, prophylaxis of vein thrombosis, vacation of daily sedation, sub glottal suction, and prophylaxis of ulcers. He also gave the evidence that supports his argument about how ER creates a direct impact on the mortality of VAP patient. However, there are no studies that give the rational evidence whether such early interventions in the ER decrease the VAP incidences (Sole el.
Clinical trial is biomedical or health related research studies in human being that follow a pre-defined protocol. Research is an activity designed to test a hypothesis that helps in concluding and developing knowledge. It is a protocol that has an objectives and procedures to reach those objectives (1). There are two types of clinical studies. One is interventional studies in which the research subjects are assigned by the investigator to a treatment or other intervention, and their outcomes are measured. Second is an observational study in which individuals are observed and their outcomes are measured by the investigators.