Archive for the ‘Emergency & Intensive Care’ Category

Caring for a patient to hospital with serious problems

Thursday, May 12th, 2011

It is not easy to face the serious illness of a relative, especially if the events fall dramatically within a few hours. Here we describe some instructions how to care patients in hospital:

care patient in hospital

First you must find the courage to smile at the patient even if the clinical situation is desperate. Especially in the case of heart disease, you always say that the situation is under control and that there is absolutely nothing to worry about. You have to be convincing and reassuring, cool and determined without ever leaking no emotion.

If you can make some jokes and talks animatedly about this and less as if nothing special was happening. This attitude will convince the patient that this is a simple matter and is in no danger. Do not whisper to anyone, especially not to make signs and do not collapse. (more…)

The importance of cleanliness in areas at risk in health facilities

Thursday, December 2nd, 2010

Hospitals are places that require extreme cleaning and disinfection of all clean rooms to avoid any kind of infection among patients. Cleanrooms are specially designed spaces for low levels of contamination. These areas must have controlled parameters such as air particulates, humidity, air pressure inside, lighting and temperature to avoid the risks of infection.

clean hospital

Depending on your level of risk, high, medium and low, and personal hygiene requirements will be much more specialized. High-risk areas are intensive care units, a prelude to operating rooms, operating rooms or areas of hemodialysis … should be cleaned and disinfected as a whole and very often, several times a day, after treatments, operations, etc. (more…)

Doctors: how to deliver bad news

Friday, November 26th, 2010

There is no doubt that doctors have the difficult task of communicating the patient bad news. Thus, we consider them experts convey negative messages. It is therefore essential to know tactful, and the Medical College (WTO) has been to work and give the keys to physicians: how to give bad news.

doctor deliver bad news

Very few people have the ability to know things have the right touch to avoid hurting anyone’s feelings. Fortunately or unfortunately, part of the work of doctors goes this way: there are times when there is no choice but to give bad news. However, there are many ways to give bad news. (more…)

The acid-base balance

Saturday, March 27th, 2010

Remember that most chemical reactions are conditioned by the pH of the medium in which the reaction takes place. Also, the majority of chemical reactions, enzymes, proteins in the body can not take place in conditions of very precise acidity necessary to maintain homeostasis.

I – Recalls:
An atom consists of a nucleus made of protons and neutrons, around which one or more electrons distributed in layers, themselves divisible into even smaller particles. Protons have a positive charge, neutrons are electrically neutral. The electrons themselves have an electrical charge opposite to that of the proton. Thus, an atom has a neutral electrical charge, with the same number of protons and electrons. The iron atom has 26 each, mercury, 80, while hydrogen, 1. The sub-components are identical, it is their number that gives them special properties. Most chemists of you will remember the periodic table of elements of DI Mendeleev.

Some elements have the ability to lose or gain electrons easily, and to relate their electrons of the outer layer. This gives respectively molecules and ions. These are the latest interest here, especially the ions from the hydrogen atom.

The first element is specificity of losing its single electron easily. Do not remain then only the positively charged proton, is denoted H +. It is the concentration of H + in a fluid which determines its acidity. (more…)

Accidents and Incidents hemodialysis

Monday, March 8th, 2010

A – Hypotension
Is found in 20 to 30% of the sessions.
There are several etiologies: An excessive decrease in the volume, inadequate peripheral vasoconstriction (diabetic patients for example), or cardiac function improperly or failed.
Clinical: Sudden fall in blood pressure, feeling sick (hot flashes, discomfort, tachycardia, possibly loss of consciousness). Yawning is often a precursor met.
What to do:

  • Reducing the speed of the pump blood ..
  • Last sloping patient.
  • Intake of saline (on prescription)
  • Eventually, put under O2 (depends on service protocols)

Prevention:

  • Never ultrafilter patients below its base weight.
  • Weight gain rigorous
  • Avoid taking anti-hypertensive before the dialysis session
  • Rate of Na in the dialysis at a concentration equal to or lower than the patient. (Reminder: the Na profile is a prescription)

B – angina
Aggravating factors: anemia, decrease in BP, in hyper-debit FAV
What to do:

  • Preventing nephrologist
  • UF minimum
  • Decreased blood flow
  • O2 nasal + scope
  • possibly following protocols, use nitroglycerin sub-lingual.
  • If the crisis continues, stopping hemodialysis, restitution, perform ECGs, biology (KPC / CPKMB / LDH etc. ….), transfer in a specialized

(more…)

Hyperkalemia

Sunday, March 7th, 2010

Recalls:
Potassium is the first intracellular cation
Usual biological values:
Extracellular: 3.5-5 mEq / L
Intracellular: 130-140 mEq / L
It achieves a critical gradient in resting membrane potential and maintains the intracellular osmolarity

Entries:
Requirements are 0.5 mmol/kg/24h
The dietary intake is essential.

Outputs:
Digestive secretions, sweat
The bulk of secretion occurs via the urine

Potassium regulation:
Definition:
Pathological state in which the potassium is greater than 5 mEq / L
Clinical signs:
Muscle fatigue, cramps
Laboratory findings: K> 5 mEq / L

Etiology:

  • Failure of excretion (renal failure)
  • Acidosis
  • Crush syndrome
  • Cell lysis
  • Adrenal insufficiency
  • Excess capital

(more…)

Anaphylactic shock

Friday, March 5th, 2010

Anaphylactic shock is a shock associated with a reaction of the organism against a particular antigen. This is therefore an immunological reaction antigen-antibody (IgE) and not a nonspecific histamine release by the action of a molecule on the membrane causes mast cell degranulation her. For example, atracurium (curare) has the distinction of being histamine particularly when it is injected quickly, it is not an anaphylactic reaction, but a non-specific histamine release in this case. However, there is a molecule that can trigger a true anaphylactic reaction.
Anaphylactic shock is an emergency
The allergens most frequently implicated are the products of iodinated contrast, quaternary ammonium compounds (curare), the beta-lactams, the wasp venom, latex, sulfites …
Anaphylactic shock is classified into four grades, depending on the size of the reaction:

Grade I : Observe mainly skin reactions with swelling, hives without marked haemodynamic compromise, sometimes preceded by premonitory symptoms such itching, burning

Grade II: In addition to a fall in blood pressure accompanied by tachycardia reaction, the patient begins to experience difficulty breathing, coughing

Grade III: The patient shows signs of previous grades with a respiratory distress, bronchospame from laryngospasm, arrhythmias and conduction

Grade IV: cardio-circulatory arrest (more…)

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