• 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

C – PAO
A etiology:

• Hypervolemia
• Acute heart failure or chronic
• Anemia
• Uncontrolled hypertension
• Drug causes (B-Blockers)
• Pump failure causing UF retro-filtration dialysis

Clinic:

• Dyspnea
• Cyanosis
• Anxiety
• Chest pain
• Cough more or less expectoration of pink frothy fluid
• Distended jugular consequences of hypervolemia and / or heart failure

What to do:

• Emergency ultra-filtration (UF isolated, it is possible to mount 2L / H on prescription in this case, it should mount a dialyzes steep)
• Oxygen nasal min 3L/min
• ECG, scope

D – Muscle cramps:
Aetiology:

• Dehydration extracellular
• Dry weight estimated too low
• UF excessive
• Na, Ca, Mg too low concentration in the dialysis

What to do:

• Stop ultra-filtration
• Prescription, Hypertonic NaCl addition and / or saline
• Rub with ice

Prevention:
On prescription, increased concentration of Na, dialysis or concentration of variable Na

E – Acute Hemolysis
Aetiology:

• Dialysate hypo / hypertonic
• T ° inappropriate
• On the CEC, closed for over a quarter of an hour, kinking, pump blood occlusive

Clinic:

• Anxiety, sweating, malaise + + +, brutal
• Back pain sudden and very intense;
• Abdominal cramps
• Tightness, dyspnea
• Presence in the circuit, blood taking an aspect of currant jelly

What to do:

• Stop UF, NOT TO REPAY
• Disconnect
• Symptomatic treatment
• Sampling of water, dialysate, the patient’s blood to determine the cause

F – Air embolism
Aetiology:

• Entry of air into the CEC
• Disconnection unsecured (withdrawal of air detector)
• Debulage, air intake on the venous tubing

Clinic:

• Polypnea
• Cyanosis
• asphyxia
• arrhythmias

What to do:

• Immediate cessation of UF
• Clamp the arterial and venous lines
• Patient sloping + + +
• Aspirate if the patient has a central lane (vacuum bubbles located right in the heart)
• Oxygen

Preventing medical and rescue support for immediate hyperbolic chamber

G – Coagulation:
Aetiology:

• No heparinization,
• failure of the pump causing an increase in PV and PTM, and a bleeding mass of the entire circuit
• Case circuit over 15 minutes

What to do:
Do not return, make a new connection circuit.

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

Electrocardiography signs:

• T wave large, symmetrical, pointed
• Then signs of disorders of the conductivity (proportional to the increase in serum potassium):
• Bifid P wave reflecting synchronization of atrial depolarization
• Enlargement of PR
• Widening of QRS complexes resulting desynchronization of ventricular depolarization
• Disappearance of P wave
• Stop Heart

Treatment and care nurse:
Electrocardiogram monitoring in CM5
Calcium gluconate: Do not lower serum potassium, but allows better tolerance (unless patient on digitalis)
Improving excretion: potassium-sparing diuretics not (furosemide)
Providers excretion: Hemodialysis
Transfers: Insulin + Glucose (intra-cell transfer).
KAYEXALATE: ion exchange resin: orally or by enema
Cathecolamines but carry the risk of tachycardia, salbutamol
If blood samples for electrolyte, avoid placing a tourniquet majorant hyperkalemia, and not too shaken sampling (risk of cell lysis).

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

Pathophysiology:
Hypersensitivity type I
Step One: Awareness
First contact with antigen (Ag) With production of antibodies (Ab) of IgE will bind to the membranes of basophils and mast cells;
Second step: contact the following:
Attachment of Ag and IgE bridge formation on the membranes of target cells,
Massive release of histamine: cutaneous vasodilation, bronchoconstriction, collapse, inhibiting the release of norepinephrine

Treatment:
Shock Grade I:

• Stop the administration of the antigenic substance suspected
• Surveillance monitoring: TA, rhythm, saturation, respiratory rate and ST segment analysis
• Intravenous
• Supine, legs elevated

Shock Grade II:
I ditto + epinephrine 10 to 20 min γ/1-2 (γ = microgram) and oxygen mask, high concentration

Shock Grade III:
adrenaline from 100 to 200 min γ/1-2

Shock Grade IV:
MCE / BAVU + adrenaline 1mg/2-3 min (some authors recommend 5mg from the third reinjection).
In shock grade II, III and IV filled with concomitant isotonic crystalloid and colloid.
C as individuals:
In pregnant women:
Setting the left lateral position to avoid vena cava and start with ephedrine (αβ indirect) than 10mg/kg. If ineffective, switch to the adrenaline.

Bronchospamse predominant:
Use of inhaled salbutamol (β2 +), if inefficient relay 100 micrograms IV bolus IV then SAP.
Inhaled nebulized epinephrine, Bricanyl
Steroids are not the first line treatment of bronchospasm
Laryngospasm predominant:
If no improvement with the combination of adrenaline and IV nebullisation, intubation in rapid sequence induction

Patient beta-blocker:
Increasing doses of epinephrine
Glucagon 1-2mg IVD / 5 min

Allergy testing:
Tryptase at 30 min 120 + / – histamine (but degrades very quickly)
Doubt whether specific IgE (eg quaternary ammonium IgE if curare suspect)
Urinary methyl-histamine after 3 to 4 hours
Investigations allergy 6-8 weeks

Results:
The excretion of 8 to 40% of vitamin B12 in 24 hours is normal. A low rate of B12 marked 57 and 58 sign intestinal malabsorption, a low rate of only 58 referrals to a pernicious anemia.

• Balancing thoraco-abdominal inspiration: mobilization of the thorax and abdomen.
• Indrawing depression abnormal chest wall, visible up to the intercostal spaces (circulation under sternum) during heavy breaths.
• This draw may also be visible above the sternum (sternal random addition). This phenomenon occurs when the entry of air into the lungs is obstructed by a mechanical obstacle.
• Funnel xiphoid.
• Flapping wings of the nose.
• Grunting.

These parameters are scored from 0 (normal) to 2 (worst condition), with Note 1 for intermediate gravity. The total score ranges from 0 (no respiratory distress) to 10 (maximum distress).
This score is a useful benchmark for assessing the lung function of newborn and its evolution, it depends on the weight and force of the child. There is no specific respiratory distress.

If the score is below 6 or 7 he indicates respiratory distress may require respiratory assistance determined by the pediatrician.

Genetic Aspect
Cystic fibrosis gene located on chromosome 7, encodes the first membrane protein called CFTR conditioning the quality of ion exchange between the glands and the lumen of the bronchus, but also upper respiratory tract, pancreas, digestive tract, the bile ducts.

Respiratory Events
Especially during the first year of life.
Then shift to attacks (super infection) characterized. Worsening respiratory symptoms with impaired general condition.
The bacterial colonization of the trachea bronchial tree is most often initially with Staphylococcus aureus or Haemophilus influenzae.
Then move to the pyocyaneus (very virulent, almost inaccessible to ATB and defense mechanisms).

Extra Respiratory Events

• Pancreatic disease (90% of cases)
• Intestinal
• Hepatobiliary
• Nutritional disorders:
  • maldigestion of fat
  • increased energy needs related respiratory disability.
• Genital Event:
• delayed puberty
• infertile men (95% of cases)
• decreased fertility in women (but may have children with a risk of having a child with ¼: genetic counseling mandatory).

Diagnosis
Easy when the typical picture combines childhood respiratory symptoms and digestive.
Difficult when the atypical forms are very moderate in their expression (bronchiectasis isolated, isolated intestinal damage, male infertility, diabetes).
At the slightest doubt, make further investigations in a specialized center, including the sweat test: this review is to determine the quantity of chlorine in sweat after collection on filter paper.
The collection is done by forearm trans-cutaneous irradiation with pilocarpine, which causes sweating at this level, or on the back and forehead sweating after saline.
The rate of chlorine in sweat is normally well below 50 mmol / l.
If rate> 60 mmol / l in children: positive
If> 70 mmol / l in adults: positive


The nasal DDB often negative values when they are high.
Standard = – 19 mv
Average CF = – 36 mv

Genetic analysis
search for a known mutation in the CFTR gene in cases of suspected cystic fibrosis (Lab specialized).

Evolution and Prognosis
The survival rate has been greatly improved in recent years: early diagnosis, advances in antibiotic treatment, care of patients in specialized centers

Prognosis Depends

• Metabolic status and respiratory
• Bronchial colonization in relation to Pseudomonas aeruginosa.
• Occurrence of complications (right heart failure, cirrhosis, pneumothorax)

Care and Treatment
Regular practice of respiratory physiotherapy
- Antibiotic therapy adapted to the ECBC (sputum):

• for loss of appetite, weight loss
• increased cough or sputum purulence
• Preventive / aerosol aminoglycosides

- Bronchodilators
- Influenza Vaccination anti systematic
- Transplant when severe hepatic cirrhosis
- Gene therapy = hope (the goal is to transfer the CFTR gene in respiratory epithelial cells patients)

Cons respiratory failure

• ANTAD, CARDIF
• medical supervision (control saturation)
• technical surveillance (check flow meters)

Supports 100% for the ALD

There may be a physician, medical officer, pharmaceutical manager, and administrator of a hospital, a nurse, medical transcriptor, medical biller, medical coder and much more. Many new medical careers related to manufacturing companies are in the areas of administration and management of medicine. Among all the different careers, one of the most intriguing and interesting is Medical coding.




The profession of medical coding involves the frequent use of alpha-numeric codes to record specific illnesses, injuries and medical procedures. This process of allocation of codes is usually done under a particular rule of coding and used throughout the world, It is used from doctor’s offices and hospitals to insurance companies and federal agencies. These codes are widely used by hospitals, nursing homes, laboratories and physicians to collect internal data and other planning objectives.

On the other hand, various insurance companies and government agencies involved with the system of health care requires codes to reimburse health care providers. One of those offered by most commercial codes is that they are still used by international health organizations to track patterns of disease and costs of health care that will enable them to take steps to prevent disease.

Medical coding certificate exam almost cover the bellow topics:

• Introduction to Medical Coding: Concepts, Tasks, literature, training coders and Leads
• The coding and directives.
• The medical literature: The case and the relevant medical records coding
• Problems and solutions during encoding: Privacy, confidentiality, data delivery
• Invoicing rules and organization
• Medical statistics
• The coding and coding quality
• Coding control of medical activity
• Case analysis and errors
• The plausibility tests
• Practical exercises and exam preparation

Definition of Night terror
Night terrors are a sleep disorder in which a person quickly awakens from sleep in a terrified state.

Causes, incidence, and risk factors:
Night terrors (sleep terrors) occur during deep sleep, usually during the first third of the night. The cause is unknown but night terrors may be triggered by fever, lack of sleep, or periods of emotional tension,stress , or conflict.


In contrast, nightmares are more common in the early morning. They may occur after someone watches frightening movies/TV shows or has an emotional experience. A person may remember the details of a dream upon awakening, and will not be disoriented after the episode.


Night terrors are most common in boys ages 5 – 7, although they also can occur in girls. They are fairly common in children ages 3 – 7, and much less common after that. Night terrors may run in families. They can occur in adults, especially with emotional tension and/or the use of alcohol.

Nails that are ragged or extend beyond the tip of the finger can cause scratches to the face and eyes.


Clean the baby’s hands, feet, and nails during regular bathing. Trim nails carefully with baby nail scissors that have blunt rounded tips or baby nail clippers. (Do NOT use adult-sized nail clippers — you may accidentally clip the tip of the baby’s finger or toe instead of the nail.)


Use a soft emery board to keep the nails smooth and prevent injuries. Since baby’s nails grow pretty quickly, you may have to cut the fingernails at least once a week. You may only need to cut the toenails a couple of times per month.