The Harborne Hospital ’s Post

***ACLS PROTOCOL, STEP STOOL & EXTERNAL CARDIAC MASSAGE TO THE BEAT OF "WELCOME HERE AGAIN"(Old Irish tune adopted as a marching song during the American Revolution********** 1)Step Stool Use During CPR. Throughout many years of practice, we observed that patients undergoing Cardiopulmonary Resuscitation (CPR) with a working arterial line, and compressions aimed at displacing the patient's sternum a routine two(2 )inches on the average for an adult patient, seemed to reach and maintain an adequate and steady Mean Arterial Pressure {MAP), and seemed to reach ROSC more promptly, whenever a step stool was used during resuscitation. The higher the operator stands with the aid of a step-stool, the greater the leverage obtained and the greater the vector of force which will be transmitted through the extended arms positioned parallel to each other and projected over the patient's chest during cardiac compressions. With the aid of step stool, the operator may even be able to stand high enough from the ground, to allow the operator to fully extend the arms and keep them straight and parallel to each other, and at the same time perpendicular to the chest of the patient during cardiopulmonary resuscitation(CPR). This way adequate compressions may be performed by simply shifting the operator's body weight back and forth over the patient's chest, with minimal energy expenditure on the part of the operator. 2) Rate of Cardiac Compressions During CPR Our anecdotal observations suggest that a rate of 120 compressions per min seemed to give us better hemodynamics during CPR and seemed to shorten the time to achieve ROSC. On a historical note, the marches played using a Fife and Drum during the American Revolutionary War like the one titled ,"Wellcome Here Again" intended to boost the morale of the troops during long marches of 20-25 miles/day, played at 120 beats a minute or the equivalent of two(2) footsteps/second. IDEA: What if to reduce operator variability during ACLS, and ensure a uniform rate of compressions of 120/min , we propose that compressions be performed to the beat of "Welcome Here Again". It may even boost the morale of the Code Blue Team.... 🤣

Journal Heart, Lung, and Circulation CS protocols ensure delivery of timely high-quality care independent of the heterogeneity in patient presentation, biases of the treating physician, and variability in nursing care [ 4 ]. In this issue of Heart, Lung, and Circulation, there are two noteworthy articles addressing both risk prediction and protocolisation of CS care [ 5 , 6 ].

Copy link to this summary Preload and Afterload Nursing | Stroke Volume, Cardiac Output ExplainedRegisteredNurseRNOverview: The lesson discusses the concepts of cardiac preload and afterload and their influences on cardiac output.Key Events:Cardiac preload refers to the volume of blood that ventricles stretch during diastole.Cardiac afterload is the pressure that ventricles have to work against to open semilunar valves.Increasing preload can be achieved through IV fluids, vasopressors, and diuretics. Decreasing preload involves diuretics and vasodilators.Increasing afterload can include pulmonary hypertension and valve problems. Decreasing afterload involves vaso dilators.Lessons Learned:Understanding preload and afterload is crucial in determining cardiac output and adjusting therapy for patients.Palliative or supportive therapies may be needed to improve patient outcomes.Long-term management of serious conditions like heart failure often requires a combination of therapies from multiple disciplines.Advice: Familiarize yourself with the concepts of preload and afterload and their implications on clinical management.Conclusion: The  emphasizes the importance of considering preload and afterload in managing cardiac function and adjusting treatment for patients with various cardiac conditions. @[email protected] 

The Power of Amiodarone 🫀 In the high-stakes realm of emergency medicine, one medication stands out as a cornerstone in the management of cardiac arrhythmias: Amiodarone. Here’s why it's a game-changer for paramedics in prehospital care: 🩸 POTENT ANTIARRHYTHMIC: Amiodarone boasts a multifaceted mechanism of action that sets it apart as a potent antiarrhythmic agent. By prolonging action potential duration and slowing conduction, particularly in ventricular arrhythmias like ventricular tachycardia (VT) and ventricular fibrillation (VF), Amiodarone effectively restores normal cardiac rhythm. Its broad spectrum of activity makes it a versatile option for paramedics facing various cardiac emergencies in the field. ❤️🩹 THERAPEUTIC EFFECTS: Unlike many other antiarrhythmic medications, Amiodarone offers the advantage of a long half-life, ensuring sustained therapeutic effects. This characteristic is invaluable during prolonged transport or in cases of recurrent arrhythmias where maintaining stable cardiac rhythm is paramount. By providing a prolonged window of action, Amiodarone enhances paramedics' ability to stabilize and manage patients in critical conditions effectively. 🔁 REENTRANT ARRHYTHMIAS: Amiodarone's unique ability to inhibit multiple cardiac ion channels, including potassium, sodium, and calcium channels, makes it effective in preventing and treating reentrant arrhythmias. By disrupting the reentry circuit and restoring normal cardiac conduction, Amiodarone not only terminates acute arrhythmias but also reduces the likelihood of their recurrence. This targeted mechanism of action enhances patient outcomes by addressing the underlying pathophysiology of arrhythmias, thereby minimizing the risk of future cardiac events. When it comes to managing cardiac arrhythmias in the field, Amiodarone isn't just a medication—it's a lifeline. Let's continue to hone our skills and knowledge to ensure we're always ready to deliver the best care possible. 💪🏼 #ParamedicLife #EmergencyMedicine #Amiodarone #PrehospitalCare #EMS #MedicalEducation 📚💊

Comparison of ductus stent versus surgical systemic to pulmonary shunt as initial palliation in patients with univentricular heart https://lnkd.in/gXTpq2Kd Patients after PDA stent had shorter ICU stay and comparable survival, but more PA interventions and lower left PA Index

“It’s fine! Everything is fine!” I will be honest with you, the patient in that picture, who is on that many life saving IV medications, with CRRT going (continuous renal replacement therapy), is definitely not fine. But as a critical care nurse, unstable patients like this is what I do best and where I thrive. I have been a critical care nurse my whole 9 year nursing career. I love the high acuity and complexities behind every patient I take care of. I love the mental challenge and putting all the pieces of the puzzle together, while actively stabilizing them in real time. I am grateful that I work in a mixed ICU, I see just about every type of patient, trauma, medical, surgical, pulmonary, neurosurgical and cardiac. Many of my patients fall into several of these categories all at the same time. For example, my patient who aspirated, developed pneumonia, is now septic, intubated, on multiple life saving IV medications and on CRRT (continuous renal replacement therapy, a type of dialysis) to combat their sepsis and renal failure from prolonged low blood pressure. YIKES! 😳 😬 My true love? Cardiac surgery patients aka fresh postoperative open heart patients. Give me a fresh post-op, open chested, with an Impella device (a machine to help their heart pump), on several life saving IV medications, open heart patient any day.  Cool Desiree, that’s great and all but how does this help me? You may ask. Remember how I mentioned I love puzzles? You know that case on your desk that is just so complex that it just looks like gibberish to you and you have no idea where the smoking gun may be? That’s where I come in! Putting complex puzzles together and knowing how all the dots connect is what I do best. What kind of cases have you had where you wish you could have had that nurse eye on? Reach out to me with any of those complex medical cases you need assistance with! [email protected]

SurgEase Innovations Ltd have some rather BIG NEWS! University Hospitals Sussex NHS Foundation Trust in partnership with Surrey Heartlands Health and Care Partnership have won the NHS England Community Diagnostic Centre Development Fund bid to trial LumenEye across the South East of England. The proposed evidence-based pathway will ensure that patients referred on the Lower Gastrointestinal Cancer Pathway with only rectal bleeding and anal symptoms and a FIT score below 40 can be referred for a digital rectoscopy examination. If they have no other symptoms, are not anaemic and have a normal abdominal and digital rectal examination they can be discharged safely from the pathway. Intermediate risk patients with a FIT between 40-80 can be referred for a CT colonography with LumenEye examination to visualise the rectum. This represents the largest co-ordinated trial of digital rectoscopy in the NHS to date with over 70% of current referrals being potentially eligible. The projected savings, release of formal endoscopy capacity and workflow efficiencies are immense and we look forward to sharing the real-world outcomes as they emerge. NHS England The Association of Coloproctology of Great Britain and Ireland (ACPGBI) Royal College of Surgeons in Ireland (RCSI) Royal College of Nursing - Company Royal College of General Practitioners #innovation #endoscopy #changemanagement #nhs #FIT

Potential new way to treat cardiac arrest patients published in recent study that included our Landmark REBOA Catheter by Dr. Austin Johnson and Dr. Scott Youngquist from the University of Utah Department of Emergency Medicine. Successful Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) deployment by emergency medicine physicians for refractory non-traumatic cardiac arrest https://lnkd.in/dnsZ2BD2 Cardiac arrest afflicts over 600,000 people annually in the United States. Rates of survival from cardiac arrest have remained stagnant for decades. REBOA is most commonly used in the management of severe hemorrhagic shock, primarily for non-compressible thoracoabdominal trauma. A growing body of evidence suggests it may serve a role in augmenting cardiac and cerebral perfusion in non-traumatic, refractory cardiac arrest. Typically, REBOA is deployed by interventional radiologists under real-time fluoroscopy. Limited data exist to demonstrate the feasibility or logistics of successful REBOA deployment in emergency departments by emergency medicine physicians. Study Highlights: - Novel emergency medicine-driven REBOA protocol for refractory cardiac arrest. - First pass success of REBOA catheterization 100%. - ROSC achieved in 37.5 % of patients, with no catheter-related complications. - A comprehensive REBOA training program ensures proficiency among emergency medicine physicians. - Demonstrates feasibility of REBOA deployment using ultrasound for placement confirmation in emergency settings. #REBOA #cardiacarrest #cardiacarrestcare #EMS #emergencymedicine

How good is a stethoscope? The pulmonary exam is incomplete without lung auscultation. Yet, most telemedicine appointments today are limited to video visits, lacking the ability to listen to the lungs or hearts using a physician’s stethoscope. At Access Pediatric, we utilize digital connected stethoscopes to remotely auscultate the lungs and hearts of our patients. How often do physicians agree with each other when they listen to the same lung sounds, or even with themselves when presented with the same lung sounds on different occasions? This question was addressed in 1986 by Dr. Cynthia Murlow and others in a seminal study titled “Observer Variability in Pulmonary Examination,” and again in 2016 by the European Respiratory Society Task Force on lung sounds in a study called “Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians’ classification of lung sounds from video recordings.” These studies were published in the Journal of General Internal Medicine and the BMJ Open Respiratory Research, respectively. Both studies found that the agreement between physicians on identifying and classifying abnormal lung sounds was poor. The best kappa (a statistical measure of agreement) was around 0.7 for the detection of wheezing, which roughly translates to physicians agreeing with each other only about 50% of the time. The agreement on other lung sounds was even lower. Until recently, overcoming this inter-observer variability was challenging. However, advancements in technology and #artificialintelligence (AI) are changing the landscape. Lung sounds vary over time. Certain sounds, such as wheezing, ronchi, or crackles, can come and go or change character at different times. For instance, they may appear only during soccer games in someone with exercise-induced asthma. When the patient visits a doctor’s office, their lung sounds might be clear. What if we could continuously monitor the lung sounds of this patient and catch abnormalities as they occur during the soccer game? What if we could use #AI to identify, classify, and quantify these abnormal lung sounds? At Access Pediatric, we have these capabilities thanks to our partnership with Strados Labs. Using cutting-edge #telehealth and remote monitoring services, combined with #AI and the Virtual First model, we provide expert medical care to children from the comfort of their homes.

POCUS in the PICU: A Narrative Review of Evidence-Based Bedside Ultrasound Techniques Ready for Prime-Time in Pediatric Critical Care https://lnkd.in/eKa6QGRM