Ambulatory Surgery Research Paper

The lack or delay in appropriate treatment for individuals who experience a sudden cardiac arrest has created a major public health disparity. Research into pre-hospital treatment and subsequent implementation has historically seen neglect by the medical and scientific community creating vast differences in survivability of cardiac arrests between demographic groups. In 2010, the American Heart Association and Emergency Cardiovascular Care program developed the 2020 impact goal to reduce death from cardiovascular disease and stroke by 20% and double out-of-hospital cardiac arrest (OHCA) survival rates (http://circ.ahajournals.org/content/121/4/586#sec-1). This has prompted a massive influx of research into the disparities that exist and an

Without early intervention on average 360,000 people out of the hospital succumb to cardiac arrest. “ Cardiac arrest and sudden death account for 60 percent of all deaths from coronary artery disease”,(Bledsoe, Porter, & Cherry, 2011,2007,2004, p. 1229) [Click and drag to move] There are several causes of sudden cardiac arrest. Most are caused by ventricular fibrillation. “During ventricular fibrillation, the ventricles do not beat normally. Instead they quiver rapidly and irregularly.” When this occurs, the heart pumps very little and blood does not get circulated throughout the body. “ Most of the cases found with sudden cardiac death are related to undetected cardiovascular disease.("Sudden Cardiac Death," 2015, para. 2)Sudden cardiac arrest are immediate and drastic that includes sudden collapse, no pulse, not breathing, and loss of consciousness. “Four rhythms produce pulseless cardiac arrest: ventricular fibrillation, rapid ventricular tachycardia, pulseless electrical activity and asystole.”("Circulation ," 2005, p. IV-58)Other signs and symptoms that could occur prior to sudden cardiac arrest, include fatigue, fainting, blackouts, dizziness,

In a specific study, following surgery, patients spent time in a rehabilitation center and had frequent, regular check-ups with the health care team. Thankfully, 90% of patients that survived the surgery had significant improvements. Limited functioning was only prevalent in 10% of the post-surgery group. In total, there were 80 people in the study, and ten of them died. Few passed away before and during surgery, while 7 of them died within one month after surgery (Rostagno et al., 2011). Factors that were related to death were: old age, lack of function in the left ventricle, and intense body wide infection. Overall, it has been concluded that the survival rate after surgery is rather high (70-85%) with a low chance of recurrence (Rostagno et al.,

It is not unknown for cabg patient’s to develop an atrial fibrillation, bundle branch or atrioventricular heart blocks post operatively. “Although these conditions are more common in older people, young people can also be affected. Heart block may also occur after heart surgery and in this case may be either temporary or permanent.” (“Tripanswers,” n.d.)

Surgical technology is an essential career because it has a great salary, is high in demand, teaches responsibility, and has been through a good deal of significant medical events. The work environment is similar wherever you go. Everything must be sterile, organized, working properly, and counted for. If not, everyone else in the operating room will suffer for it.

The appropriate assessment of patients prior to surgery to identify coexisting medical problems and to plan peri-operative care is of increasing importance. The goals of peri-operative assessment are to identify important medical issues in order to optimise their treatment, inform the patient of the risks associated with surgery, and ensure care is provided in an appropriate environment secondly to identify important social issues which may have a bearing on the planned procedure and the recovery period and to familiarise the patient with the planned procedure and the hospital processes.(American Society of Anaesthesiologists)

Per the study, the “findings have a few important implications. A substantial minority of patients aged 80 and older who have major noncardiac surgery die or suffer a postoperative complication, but the majority have good outcomes, and for many operations, mortality rates were low (>2%).” The

This paper will be going over a scenario involving a real patient and what things could have been different with EMS care. It will also be covering what exactly cardiac arrest is and what rhythms produce it. And for every cardiac rhythm in cardiac arrest, there is a specific treatment plan paramedics can follow.

While numbers from the study may appear to show a positive improvement, the account of out-of-hospital neurological and physical deficits arising from the event are not shown throughout the study and need to be taken into consideration. The American Heart Association acknowledges the study and also acknowledges that there is not enough evidence to support they use or the lack of ACLS medications during a cardiac arrest.

Vasoplegic syndrome is a severe vasodilatory shock characterised by hypotension, tachycardia, normal or elevated cardiac output, decrease in systemic vascular resistance, poor or no response to fluid resuscitation and vasopressor administration [1]. Though it is commonly seen during cardiac surgery, it is also been reported during non cardiac surgery [2,3]. The incidence of vasoplegic syndrome is 8-10% in cardiac surgery [4], and its risk factors include intravenous heparin, beta-blockers, calcium channel blockers, renin angiotensin system antagonists, protamine use, myocardial dysfunction, diabetes mellitus, presence of pre-cardiopulmonary bypass hemodynamic instability, increased duration of cardiopulmonary bypass and ventricular device insertion [5]. We present a case of successful management of vasoplegic syndrome the developed perioperatively following Whipple’s procedure.

In previous literature, patients have demonstrated and expressed feelings of helplessness, powerlessness and anxiety (6,9). Surgical interventions and procedures invoke strong reactions around pain, complication risk and death for the patient and their families (5). Additionally, in the preoperative phase of waiting to be transferred to the operating room, previous studies have shown that this can be the most frightening time for many patients (5,6,9). When this preoperative waiting time is compounded with the sudden cancellation or postponement of a patient’s surgery, many patients experience heightened negative effects (5,9).

Ambulatory care comprises health care services that do not require overnight hospitalization. (Sultz, Young , p. 129). An improved process would have the patient as its focus, considering the effective use of varying levels of providers managing each step of the clinical visit to properly gather information, reducing the number of interactions, and improving the patient experience while providing a better set of outcomes (Backer & Asso). Also ambulatory care facilities are mainly for invasive techniques that are replacing the complex, inpatient procedures.

American Heart Association (AHA) estimates that nearly 700 Americans die each day of sudden cardiac arrest (MI), or 250,000 every year, as many as 50,000 lives could be saved each year if certain critical interventions were made. (Freeman , 50) A patient who receives early life support measures and defibrillation within one to five minutes of arrest is much more likely to live and to retain normal brain function. The brain is often at a serious risk for irreparable brain damage related to anoxia and many other co-morbidities that are associated with cardiac arrest (MI). When a perfusing cardiac rhythm returns after a heart attack, the most important objective is to preserve brain function. The AHA and the Advanced Life Support Task Force of

The King County Emergency Medical System is recognized as being the best in the world, especially in treatment of acute cardiac arrest (Public Health Insider, 2014). The system has several main strengths; superior communications and human resources, highly trained staff and adequate number of units, and research

The three major life-breathing concerns for a patient is a disruption of the airway, breathing, and circulation. When a patient goes into cardiac arrest due to pre-existing conditions or trauma, an EMT will initiate the steps of cardiopulmonary resuscitation (CPR) and hopefully using an available automated external defibrillator (AED). However, some patients due to having a terminal illness, age, or personal choice does not want to be resuscitated or have